HomeMy WebLinkAboutHYDRANT PERMIT - 21-00949 - Bateman-Hall Construction FHM 18SIRE HYDRANT USE PERMIT 3•"" CITY b'
NONTRADITIONAL WATER CUSTOMERSil.=. �' P„"�3
33 N Y���+'CW
LiR*Xbfg,
0 8344p Naan ahorlyanO�sztwp.ap Frons: 208.372-2136 AUMM*b f0P*
Date Issued WWW rexbvop.ap Fac 877347. W17
Busln Meter # 1 Hose Number.
e55 Hartle; Permit #2
Picked up by; �AU.770�ilyhone # ��
Address: ��8�i Z70 IS21i Phone #
7 -1
City State Z-
ta OR.
i
��ig- pO 2G Z
F/! Year Issued:
Deposit amt: (Receipt Code=� /i� �3y�3 e= MIlSCG)
,l $2,000 _ 2" Water Meter WDEP) with credit cards charge an additional 3.5% (Rec ipt Cod
800 - 1" Water Meter Deposit retained? or refunded? —
" ' CONDITIONS OF P
In order to ERMIT:
desiringprevent possible contamination from backflow of the Rexburg city water system, any persons or entity
to obtain water from a City fire hydrant must comply with the following:
}Gt. ' 1• Obtain a written Y Y P Y in to take any water.
¢ � 2• Take Permit from Rexburg City Hall, 35 N 1 East, before attempting
water only from the one fire hydrant designated by the city water department.
3,
Check out the backflow and metering device from the city water dept. to be attached to the fire hydrant
4
agreed upon b the user and the citywater de tment.
Y
As indicated above a deposit will be required on any metering device. Any damage to or loss of the device
+4j 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.)
f +� 5. The fee for any water obtained through the metering device is as follows:
,>� r 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.
Any person or entity not complying with this policy shall be assessed a penalty charge of $400 in addition
to the normal charge for the water taken.
REFUND TO:
METER OK:
YES OUT READ
NO IN READ
GAL. USED
READ DATE
METER RE -ISSUED? YES/NO
Issued by:de�
GJ�ire Li �ibtti � wrc.��
CHARGES:
METER MAINT
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
TOTAL
Received by:
10.00