HomeMy WebLinkAboutHYDRANT PERMIT - 20-00344 - Headwaters Construction FHM #770T Yf1FOX
FIRE HYDRANT USE PERMIT ?�., CITT OF
t#OWLADMONALWATER CWC M:s5 ;= t
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ZZ 359,302Z
Date tsswea S f249 Meter a rmIV%I Jf�7 A 10 4�2-
3usmness Phone a $ 66 "Ygb � f ab 6
Ptckc +,p by 71. e '"�k Phones Zr43 276" 9Y/L
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f 20
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51.600 targe Capacity water Mercer
5 60C Sma,i Capacity Wa' :'e:er
CON D('I lONS 0' '. =;MfT.
in Order toy = . e " :css.ble corrtammation from baddlow of the Rodxxg city water system, any Phu Or
entity desir - Anter from a city fire hydrantmust comply with the foilawiltg
L Obtain a writ : - : e _ from N %buFg City KA 35 N 1` East, before atteffWUM to tame any watef.
2 Take water or,Y f -,a ^a `'e hydrn[ designated by the city water dePadlTu st-
3. Check Out the bwe ., : s-..erkV device from the city water dept. to be attached to the *e bFira t
agreed ulpoe by the user : the city water depO nen
4. As iWkACd above a depcnt wd be required on any meterwg dewoe- Any damage to or loss of the device
u17 be paid for by the user. After any use, fepow, orrepWommmadnages are deduced .the balance of the
deposit wi be refunded to the user. (City water dept. wN Oontdtict a firm inspection.)
5. The fee for any nater ouuwwd thrmO the mrWft device is as borows:
fee: 1-1AW plum $10.00 Each 1AW tams th0fe9W : 55-W
6. A $50.00 maintenance fee for Y and psm maintenance tee for Y wlr be assessed each year for
maff tenarwe on the Meter-
Any
person of COMP not complying with this policy shall be mewed a Penalty charge of S400 in addiboo
to the nostnal charge for the water taken.
Ora
Signature of Applicam
REFUND T0:
METER OK:
V ^
YES OUT READ 7 b�--
NO IN READ —
GAL. USED
READ DATE
METER REISSUED? YES / NO
CHARGES:
METER MAINT,
o- i00o GAL
ADDITIONAL WATER
REPAIRS -PARTS
TOTAL
Al�Ci
pion Data f'.a'ad* Tra�rser