HomeMy WebLinkAboutHYDRANT PERMIT - 21-00866 - Depatco FHM #22//
/y Sf
1
Nw,4
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
35 North IstEast Nooh.phetheon4rexburg.org Phone: 208.372-2136
Rexburg, ID 83440 www.rexburg.org Fax: 877.397.3917
Date Issu
Business name
Picked up by
Address:
Meter #
Permit #
�����/� Phone #
Phone #
LOCW414.b ^ ,1�/a
Year Issued: ZO2
2
0
REXBURG
Amemal lalv 1 umm"h1 y
Hose Number: /.r
Deposit amt: (Receipt Code= WDEP) with credit cards charge an additional 3.5% (Receipt Code= MISCG)
$1,800 - 2" Water Meter ✓ Deposit retained? or refunded? &A
$ 800 - 1" Water Meter ( date)
CONDITIONS OF PERMIT:
in order to prevent possible contamination from backflow of the Rexburg city water system, any persons or entity
desiring to obtain water from a city fire hydrant must comply with the following:
1. Obtain a written permit from Rexburg City Hall, 35 N V East, before attempting to take any water.
2. Take water only from the one fire hydrant designated by the city water department.
`i 3. Checkout the backflow and metering device from the city water dept. to be attached to the fire hydrant
2 agreed upon by the user and the city water deptment.
4. As indicated above a deposit will be required on any metering device. Any damage to or loss of the device
will be paid for by the user. After any use, repair, or replacement charges are deducted ,the balance of the
deposit will be refunded to the user. (City water dept. will conduct a final inspection.)
5. The fee for any water obtained through the metering device is as follows:
Fee: 1-1,000 gallons $10.00 Each 1,000 gallons thereafter: $5.00
6. A $50.00 maintenance fee for 1" and $75.00 maintenance fee for 2" will be assessed each year for
r maintenance on the meter.
7. The meter needs to be returned by 12/1 for testing calibrations. A meter can be reissued the same day per
request if needed.
Any person or entity not complying with this po icy sh I be assessed a penalty charge of $400 in addition
Jr% X to the normal charge for the water ta�
N
Signature of Applicant
REFUND TO:
METER OK: YES OUT READ CHARGES:
NO IN READ METER MAINT 75.00
GAL. USED 0- 1000 GAL 10.00
READ DATE
�jMETER RE -ISSUED?
Issued by:
YES/NO
ADDITIONAL WATER
REPAIRS -PARTS
TOTAL
Received by: