HomeMy WebLinkAboutHYDRANT PERMIT 2 - 21-00945 - Jason Rennaker FHM 30with the following:
L" East, before attempting to take any water. G,
by the city water department. I -
city water dept. to be attached to the fire hydran' cI E RA r.
tetering device. Any damage to or loss of the dev f NONTRADITIONAL
NDApIT� INT USE PER11a 1T
placement charges are deducted ,the balance of Zr
3,5 r,/,.�Noah Phelart ONAL WgTER CUSTOMERS �,will conduct a final insPe�ionJ Date hWI texbur r-�`�Xv1RG
Iw�'�'.rexbur9 org Fhon
levice is as follows: z g.org e: 208.372-2136 ""
Ions thereafter : $5.0o year for Z. Fox' 877.397.3917 Am rlw! Futility (l mmumly
nce fee for 2" will be assessed each y Business Warne; Meter # 3
Oh Permit # Q
,rations. A meter can be reissued the sHose Number: 2 6
ame da Picked U ��h�2u a-i
UP by: Phone #_ 50? 7T2, 1311
Address: 3�•
penalty charge of $400 in ac Cie Phone)#
assessed a p City State Zip; exZ l�6GL�riAa� `,, Dl� �•��� -pills �e
/A �cfG �1dw.w1 da
(ReceiptCod
Deposit amt: Year Issued:3-t �r
e=
Ircan WDEP
$2,000 - 2" Water Meter ) with credit cards charge an additional 3.5% (Receipt Code= MISCG)
$ 800 - 1rr Water Deposit retained?
Meter or refunded?6/1
CONDITIONS OF PERMIT: ( date)
:HilETER 7 In order to prevent possible contamination from backflow of the Rexburg cit waters stem, an
METER MAINT 1� desiring to obtain water from a city fire hydrant must comply with the following:
� 1OOp GAL g y y y persons or entity
%DDIT
TER �� 1. Obtain a written permit from Rexburg City Hall, 35 N 1'` East, before attempting to take any water.
RiEpAI SNDA TS —_ 2, Take water only from the one fire hydrant designated by the city water department. s
REPAIRS-PARTS \
TOTAL 3. Check out the backflow and metering device from the city water dept. to be attached to the fire hydrant 7
,y: 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 77
will be paid for by the user. After any use, repair, or replacement charges are deducted ,the balance of the (� 1
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: N 9
Fee: 1 – 1,000 gallons $10.00 Each 1,000 gallons thereafter : $5.00 n
6. A $50.00 maintenance fee for 1" and $75.00 maintenance fee for 2" will be assessed each year for 2�
maintenance on the meter. S
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. 5
Any person or entity not complyingwith this cy shall be assessed a penalty charge of $400 in addition
�sto the normal charge for the water tak �
ignature of Applicantake s
ear @p re to
REFUND TO: 8 g 9 Al
METER OK: YES OUT AD CHARGES: METER MAINT Prf��ble
NO READ
GAL. USED _316 0- 1000 GAL 10.00
READ DATE ADDITIONAL WATER
METER RE-ISSUED? YES/ NO REPAIRS-PARTS
TOTAIe
issued by:�VIIIIIIIIII a Kisill
Received by:
till Ork-�7'G/j7�G� fL�l jGs�
%� 025
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