HomeMy WebLinkAboutHYDRANT PERMIT - 22-00178 - Rexburg Waste Water Collections FHM 3435 North Ist East
Rexburg, ID 83110
Picked up by
HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
Noah.phetheon®rexbuig. org
www.rexburg.org
Phone: 208.372.2136
Fox; 877 397.3917
Permit #t
2 Phone a
CITY OF
REXBURG
Amoriwi Nmilr (ymmunify
nose Number: &%,f,
Year Issued:
Deposit amt: (Receipt Code- WD P) with credit cards charge ap additional 3.5% (Receipt Code= MISCG)
$1,800 - 2" Water Meter
$ 800 - 1" Deposit retained?Iv or refunded?
Water Meter
CONDITIONS OF PERMIT: ( date)
1, order to prevent possible contamination from backflow of the Rexburg city waters stem, any persons
desiring to obtain water from a city fire hydrant must comply with the following: y
1. Obtain a written permit from Rexburg City Hall, 35 N 1't East, before attempting to take any watery entity
20 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.
S
Signatur ofArinlirnnt
REFUND TO:
METER OK:
Issued by:
r Ca OUT READ
NO IN READ
GAL. USED _
READ DATE _
METER REISSUED?
CHARGES:
METER MAINT
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
Received by:
TOTAL
75.00
10.00
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