HomeMy WebLinkAboutHYDRANT PERMIT 2 - 21-00866 - Depatco FHM #22 City ProjectNONTRADITIONAL WATIR CUSToMIRS -' l It op
REXBURG
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Deposit amt; (Receipt Cody; WDE:P) with credit cards charge an (Rucri tt (u(1r • MISCG)
$1.840 - 2” Water Meter Deposit retained? u. 1 rfunded? ,
$ 804.1" Watvw�er Mater _ ( date)
CONDITIONS OF PERMIT,
In order order to prevent possible contamination from backflow of the Rexburg city water sy%tom, 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, 95 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, 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 po icy sh I be assessed a penalty charge of $400 in addition
to the normal charge for the water take
Signature of Applicant
REFUND TO:
METER OK:
YES OUT READ '�-'/
NO IN READ
GAL. USED
READ DATE
METER RE -ISSUED? YES/NO
Issued by: 47 `� 4
CHARGES:
METER MAINT
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
75.00
10.00
TOTAL --
Received by:
OOC4