HomeMy WebLinkAboutHYDRANT PERMIT - 22-00231 - Depatco FHM 5Ylti�e "
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35 North 15t East
Rexburg, ID 83440
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS be
Noah.phethean(rexburg.org Phone: 208.372 2136
www.rexburg.org Fax: 877.397.3917
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Date Issued %Z/ �Z Z Meter # s Hose Number: .5
—
Permit #
Business name: r 'f! WJ GU Phone # Q0 S`di 4/00c>
Picked up by: Phone # 206 -20 t ' G -7 1 '7
Address: V1eW CAry..c
City State Zip:-6ttS Tda_,.o Year Issued: Sd LZ
Deposit amt: (Receipt Code= WDEP) with credit cards charge an additional 3.5% (Receipt Code= MISCG)
$2,000 - 2" Water Meter Deposit retained? or refunded? f/ose 3
$ 800 - 1" Water Meter ( date)
CONDITIONS OF PERMIT:
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:
I. Obtain a written permit from Rexburg City Hall, 35 N 1s` 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 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.
REFUND TO:
METER OK: YES OUT READ /
NO IN READ
GAL, USED
READ DATE
Signature of Applicant
ETER RE -ISSUED? YES / NO
Issued by:
Y
CHARGES:
METER MAINT
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
TOTA�j
Received by: r >e�c�c
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