HomeMy WebLinkAboutHYDRANT PERMIT 2 - 21-00024 - Headwaters Construction FHM 29e9S,�
ro`�i
n'"d.
12142 CWMETERR
12215 W ATER LEP
12226 CW METER
12231 CW METEp
12251 ULDGLNR
12300 CW METE
12305 CW MET'
12354 C�N
12356 CW
12366 Wil
12400 CW M
12447 CW ti
12599 CW I
12611 UO
12632 111
12689 C
12718
12745
1-279c
128-
12F
12
1
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
35 North IstEast
Noah.phethean@rexburg.org
Phone:
208.372-2136
Rexburg, ID 83440
www.rexburg.org
Fax:
877.397.3917
C I TY OF
REXBURG
nr
Americas family Community
Date Issued ///3 /,ZMeter # cZ9 Hose Number:/ &
Permit # 2/ —006jZ if
Business name: ►� �9 tJ�'(a5R S CouS I • Phone # Tog — 313- iZ! 0
Picked up by 'r '7 Phone /# 5Amr
Te
Address: _ /�9go &eet,..� /�, 44 Iv Dom: � 4pwll�o& r��^^--L
49C.Fkri.�„ (S2 Year Issued: Zd��
Deposit amt: (Receipt Code= WD�P) with credit cards charge an itional 3.5% (Receipt Code= MISCG)
$1,800 - 2" Water Meter Deposit retained? or refunded?
$ 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.
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.
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. /I
Signature of Applicant
REFUND TO:
METER OK: YES OUT READ rZ. S6 CHARGES:
NO IN READ 206 METER MAINT
GAL. USED 0- 1000 GAL
READ DATE _ ADDITIONAL WATER
METER RE -ISSUED? YES/ REPAIRS -PARTS
TOTAL
Issued by: j _ Received by: L-ej
75.00
10.00
),10'flit lh,Il, IIt,bl,Ilttb4Nslllh
Danny Butterfield
40