HomeMy WebLinkAboutHYDRANT USE PERMIT - 23-00897 - HK Contractors FHM 10FIRE HYDRANT USE PERMIT
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f4t'ir. �� (�S year Issued:
C!b State Zip:_
Deposit arrlt: (Receipt Code=WW��/ 1with credit cards dale an ad i ?(Receipt code= IASC'G)
S�205W - Y Water Meter � Deposal retsined�
( date)
$ 800 -1' Water Meter
"� , • r COND(TWI �lS Of PIEWhI coetan►ination from backfiow of the Rexburg
water system. any persons Or entity
awarder to prevent
possible
'tram a c h fire hydrant must com* with the following:
L obtun a written permit from Rexburg City HA 35 N 1' East before attempting to take any water.
Z Take water only from the one fire hydrant designated by the city water department.
3_ Check out the baddlow and metering device from the city water dept. to be attached to the fire hydrant
weed 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 rK toss of the device
Frtlleyr replacement
charges are deducted .the balance of the
SotF.,,_ Aer with be paid for by the user- After any use, repair. or replacem
Tar 'tY. Arc, deposit w9al be refunded to the user. (City water dept. will conduct a final inspection.)
�Dl WW= ;eqm17 the metering device is as folbws:
Srrb!!Yra,�Ind III 5_ The fee for any water obtained through gallons thereafter: $5.00
- 'ao Fee: 1-1,000 gallons $10.00 Each 1,000
6- A 5W.00 maintenancefee for 1' and $75.00 maintenance fee for 2' will be assessed each year
for
maintenance on the meter. reissued the same day per
�nmlie 7 The meter needs to be retumed by 12/1 for testing calibrations. A meter can be
or
(good request if needed -
Any person or entity not complying with this policy shall be assessed a penalty charge of $400 in addition
*e"Se. He 1have a to the normal charge for the water taken.
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'w �P iLske ro test fomo Signature of Applicant
We areius PP
REFUND TO:
METER OK:
YES OUT READ
NO IN READ
GAL. USED
READ DATE
METER RE -ISSUED? YES / NO
Issued by:
CHARGES:
METER MAINT
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
Received by:
TOTAL
10.00
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