HomeMy WebLinkAboutHYDRANT PERMIT 3 - 21-00484 - HK Contractors FHM 1 City Project00,
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FIRE HYDRANT USE PERMITOggNONTRADITIONAL WATER CUSTOMERS Ric iYTr joTNT�
35 North I st Eost +__�+_-�_j w v RG
Rexburg, 10 83440 Noah.Phetheon*rexburV.o,, Phone: 208.372-2136 nr
h'"�'W. rexbur or AmsnwilvmAy (IlmmyntlY
Date Issued g• fl Fox: 877.397.3917
z n ,. ,
Meter # _ / Hose Number:
Business name: Permit #_ gl—t>4>1 y --J
Picked up by Phone #
Address:
Phone # Z 0 $
/J
L Year issued��
Deposit amt: (Receipt Code= WDEP) with credit cards charge o
$1,800 - 2" water Meter g an additional 3.5/0 (Receipt Code= MISCG)
—�Deposit retained?_ /mor refunded?
$ 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:
1. Obtain a written permit from Rexburg City Hall, 35 N 1`r 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.)
S. The fee for any water obtained through the metering device is as follows: �tf'{/ pr4o
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
to the normal
charge
for
the water
taken. -.4:�;'
/
assessed a penalty charge of $400 in addition
Signature of Applicant
REFUND TO:
METER OK: YES OUT READ k5"c S
NO IN READ R.g At
GAL. USED .0490
READ DATE
1E,TER RE -ISSUED? YES /�O
CHARGES:
METER MAINT
0-1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
TOTAL
Issued by: ly Received by:
75.00
10.00
.,aff`