HomeMy WebLinkAboutHYDRANT PERMIT - 22-00075 - High Plains Drilling #30z 'Y �
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35 North Ist East
Rexburg, ID 83440
Date
FIRE HYDRANT USE PERMIT ,.••x•
CITY OF
NONTRADITIONAL WATER CUSTOMERS IZEXBLIRG
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Noah.phetheon Zrexburg.org Phone: 208.372-2136 F 'Iy commumry
www.rexburg.org Fax: 877.397.3917
Meter # 30 Hose
Permit # 72.AOn=4�
Business name: /�L�r��f� Phone #
-P Fr'111V_ 122 aoO ' o Phone #
Address:
posit amt: (Receipt Code=
$1,800 - 2" Water Meter _
$ 800 - 1" Water Meter
CONDITIONS OF PERMIT:
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Year Issued: zoze
with credit cards charge an additional 3.5% (Receipt Code= M\SCG)
Deposit retained? or refunded?
(late)
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 1s` East, before attemptingto 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: \ 7`bu
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 Y
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.
Signature of Applicant
REFUND TO: It
METER OK: YES x OUT READ X93 , CHARGES:
NO IN READ METER MAINT 75.00
GAL. USED 0-1000 GAL 10.00
READ DATE
METER RE -ISSUED? YES / NO
Issued by: Roof 07 V
ADDITIONAL W ATER
REP AIRS -P ARTS
Received by:
TOTAL
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