HomeMy WebLinkAboutHYDRANT PERMIT 2 - 21-00606 - Rexburg Waste Water Collections FHM 34=A0F4kfr1"er7t
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747,7Me,
35 North 1 st East
Rexburg. ID 83440
Date
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
Noah.phetheon @rexburg.org
www.rexburg.org
Phone: 208.372-2136
Fax: 877.397.3917
Meter #1
Permit #
Business name: VA—d fA►V L p1Yj(N��^�
Picked up by Co%j
Address:
Phone #
Phone #
Year Issued: 1v1
CITY OF
REXBURG
Amrriuu Family Community
Hose Number: N&eno_C
Deposit amt: (Receipt Code= WDE ) with credit cards charge �a��n additional 3.5% (Receipt Code= MISCG)
$1,800 - 2" Water Meter �- Deposit retained? 0— or refunded?
$ 800 - 1" Water Meter (date)
CONDITIONS OF PERMIT: persons or entity
In order to prevent possible contamination from backflow of the Rexburg city water system, any
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 11t East, before attempting to take any water.
2. 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 loss of the device
will be paid for by the user. After any use, repair, or replacement charges are deductedd ,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.
REFUND TO:
METER OK: YES OUT READ
NO IN READ
Issued by:
GAL. USED
READ DATE
Applicant
METER RE -ISSUED? YES/NO
CHARGES:
METER MAINT
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
TOTAL 3 �,j
Received by:
75.00
10.00