HomeMy WebLinkAboutFIRE HYDRANT PERMIT - 22-00763 - Rexburg Power Washing FHM 9 (2)In order to pre\
desiring to obta
1. Obtain
2. Take wat
3, Checkou
agreed up
4. As Indicate
will be paic
deposit will
5. The fee for
Fee:
6. A $50.00 ma
maintenance
7. The meter ne
request if nee
Any person or entity
to the normal charge
REFUND TO:
METER OK: YES _
NO
Issued by: a4 46
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
35 North Ist East
Noah. phetheon®rexburg.org
Phone:
208.372-2136
Rexburg, ID 83440
www.rexburg.org
Fax:
877.397.3917
Date I
Business name
Picked up by
Meter #
C I TY OF
REXBURG
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Amerha5 Homily Community
Hose Number:
-- P//ermit# D� 3n
('Du Gr Wl�l�i�1A Phone # 9*77 _ I/3!�`
Phone #
Address: °X�ia�,� �/� (/go Local;on: a' �a�
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Year Issued: 2402Z
Deposit amt: (Receipt Code= WDEP) with credit cards charge an additional 3.5% (Recejpt Code= MISCG)
$1,800 - 2" Water Meter Deposit retained? or refunded?
$ 800 - 1" Water Meter V ( 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" East, before attempting to 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. 1
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 f e n
deposit will be refunded to the user. (City water dept. will conduct a final inspection.) I r ll
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 assesse 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.
Signature of Applicant
REFUND T0:
METER OK: YES OUT READ - �S CHARGE
NO IN READ 4 1 J �' ��/, METER MAINZ /1)00 ./rn�n��-^�
GAL, USED 0 1000 GAI. Irl nn
READ DATE ADDITIONAL WATER
METFR RF ISSUED? Yl % / Nt I REPAIRS -PARTS
r /,(
Issued by: g Received by, IV PA--
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