HomeMy WebLinkAboutHYDRANT PERMIT 2 - 20-00802 - Big-D Construction FHM #9FIRE HYDRA T USE PERMIT °4
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NONTRADITIO AL WATER CUSTOMERS CITY a F
REXBURG
35 North lstEast Noah.phethean@rexburg.org Phone: 208.372-2736 ro
Rexburg, ID 83440 _ www.rexbur.or AmedcarFomilyCommnity
www.rexburg.org Fax: 877.397.39)7
Date Issued_ f�f/z,,.,__ M7miry
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Business name: %� i 6 - I � ,o . , __
Phone Zag- z-() Picked up by R , Phone # 2 -.70A.
Address: 4r-/ ti A t
dl7 2- Year Issued: �a
Deposit amt: (Receipt Code= WDEP) with credit crds charge an additional 3.5% (Receipt Code= MISCG)
$1,800 - 2" Water Meter Deposit tained? or refunded?
$ 800 - 1" Water Meter X date)
CONDITIONS OF PERMIT:
In order to prevent possible contamination from back ow of the Rexburg city water system, any persons or entity
desiring to obtain water from a city fire hydrant must mply with the following:
1. Obtain a written permit from Rexburg City Hal 35 N 1't East, before attempting to take any water.
2. Take water only from the one fire hydrant des nated by the city water department.
3. Checkout the backflow and metering device f m the city water dept. to be attached to the fire hydrant
agreed upon by the user and the city water de tment.
4. As indicated above a deposit will be required any metering device. Any damage to or loss of the device
will be paid for by the user. After any use, rep r, or replacement charges are deducted ,the balance of the
deposit will be refunded to the user. (City wat r dept. will conduct a final inspection.)
5. The fee for any water obtained through them tering device is as follows: rl /
Fee: 1-1,000 gallons $10,00 Each 000 gallons thereafter -.$5.00 , C A t � %e
6. A $50.00 maintenance fee for 1" and $75.00 aintenance fee for 2" will be assessed each year for P"
maintenance on the meter.
7. The meter needs to be returned by 12/1 for to ing calibrations. A meter can be reissued the same day per
request if needed.
Any person or entity not complying with this poli shall be assessed a penalty charge of $4013 in a0d'ition VeT
to the normal charge for the water taken.
S, of pplicant
REFUND TO:
METER OK: YES OUT READ 6 9 CHARGES:
NO IN READ 70METER MAINT 75.00
GAL. USED 1 0- 1000 GAL 10.00
READ DATE ADDITIONAL WATER
METER RE -ISSUED? YES / NIO REPAIRS-PARTS
� TOTAL
Issued by: C;'e Received by: i tI