HomeMy WebLinkAboutHYDRANT PERMIT - 21-00484 - HK Contractors FHM 1Chuck Ve
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Date
FIRE HYDRANT
USE
PERMIT
,Y,° •,
i C ITY O F
NONTRADITIONAL
WATER
CUSTOMERS
'o
UXBURG
Ow --
35North lstEast Nooh.phethean®rexburg.org
Phone:
208.372-2136
Anlfdwn Nnilly C°mmamry
Rexburg, ID 83440 www.rexburg.org
Fox:
877.397.3917
Meter# / Hose Number:
// Permit #
Business name: K r Phone # — L 0
Picked up by Phone # y qz� 'zi�
Address: LOGa.� dn: /2 . l-ys�-
4 p �Q ��S Year Issued:
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?
$ 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 1" East, before attempting to take any water.
2. Take 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
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. _ n
REFUND T0:
METER OK: YES
NO
OUT READ 299 clR CHARGES:
IN READ
GAL. USED
READ DATE
ETTER RE -ISSUED? YES/NO
Issued by:fy
rte"
METER MAINT
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
Received by:
75.00
10.00
�a Orin Un10APA 24-05 01 Rule
t; Water 8 Wastewatl
isible charge or substitute responsible char
�er than the classificatic waec
operator is in reson of the siponsible bcharge. The types o
crating personnel shall only act in accorda
C or substitute responsible charge of a
the classification of the public wasteware
operator ewate
nt. is In responsible charge. The 1
luals licensed as backflow assembly test
L4, Chapter 24, Idaho Code.
herthano hall practice only under the dl
at any than op
tem.rator-in-training. No ape
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