HomeMy WebLinkAboutHYDRANT PERMIT - 21-00945 - Jason Rennaker FHM 30Address: 3g9rJ i�d
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Grl f�DCO�IVD n �" I� �St D���:-CAra
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City State lip: l�� �Ioy Year Issued: Ze L /bwrwl
Deposit amt: (Receipt Code= WDEP) with credit cards charge an additional 3.5% (Receipt Code= MISCG)
$2,000 - 2" Water Meter v- Deposit retained? or refunded? y'*�—
$ 800 - 1" Water Meter ( date)
CONDITIONS OF PERMIT,-
In
ERMIT: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.
3. Checkout the backflow and metering device from the city water dept, to be attached to the fire hydrant
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
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.
person or entity not complying with this cy shall be assessed a penalty charge of $400 in addition
he normal charge for the water tak
ignature of Applicant
1ND T0:
ER OK: YES OUT AD S' CHARGES:
NO READ METER MAINT
GAL, USED 0- 1000 GAL 10.00
READ DATE ADDITIONAL WATER
METER RE -ISSUED? YES / NO
by:
REPAIRS -PARTS
TOTAL
Received by:
� -- t",rl% " �fda�okr
FIRE HYDRANT USE
PERMIT
NONTRADITIONAL WATER
CUSTOMERS 5`
CITY „„
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1.1 C' V 1�.V
33 North hl Eoar
NacftphNhejanQrexburp,org Phone;
208,372 2136m0
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ArnxNtat ham0y i;nrnmunHy
Hrxpurp ID 90440
www.rexburp.ora Fox.
877,397.3917
11.11r Issued /
Meter#
Hose Number: Z
Permit M
Uuslness name:
_
Phone—�70
7T Z 1311
Picked up by:
Phone It
Address: 3g9rJ i�d
ie��g!
Grl f�DCO�IVD n �" I� �St D���:-CAra
Gr -
City State lip: l�� �Ioy Year Issued: Ze L /bwrwl
Deposit amt: (Receipt Code= WDEP) with credit cards charge an additional 3.5% (Receipt Code= MISCG)
$2,000 - 2" Water Meter v- Deposit retained? or refunded? y'*�—
$ 800 - 1" Water Meter ( date)
CONDITIONS OF PERMIT,-
In
ERMIT: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.
3. Checkout the backflow and metering device from the city water dept, to be attached to the fire hydrant
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
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.
person or entity not complying with this cy shall be assessed a penalty charge of $400 in addition
he normal charge for the water tak
ignature of Applicant
1ND T0:
ER OK: YES OUT AD S' CHARGES:
NO READ METER MAINT
GAL, USED 0- 1000 GAL 10.00
READ DATE ADDITIONAL WATER
METER RE -ISSUED? YES / NO
by:
REPAIRS -PARTS
TOTAL
Received by:
� -- t",rl% " �fda�okr