HomeMy WebLinkAboutHYDRANT USE PERMIT - 23-00740 - HK Contractors FHM 253S North 1st Eost
ReA"g, ID 83410
Date
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
Nooh,phethe0n*Mxbu9•09 wane', 208.372-2136
www.rexburg,org Fax:877.397,3917
Meter d
Permit q
Business name:Phone q
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Hose Number:
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City State 21p: � �� Year Issued; -
Deposit amt: (Receipt Code= WDEpjwith credit cards charge an additional 3.5% (Receipt Code= MISCG)
$2,S00 - 2" Water Meter Deposit retained? or refunded?
$ Soo - 1" Water Meter ( datal
CONDITIONS OF PERMIT:
In order to prevent possible contamination from backnow of the Rexburg city water system, any persons or entity
des" to obtain water from a city fire hydrant must comply with the following:
1, Obtain a written parmlt from Rexburg City Hall, 35 N V 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,
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:
Fee: 1— L000 gallons $10.00 Each 1,000 gallons thereafter : $5.00
6, A $5o.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 retumed by 12/1 for testing calibrations, A meter can be relssued 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 /YZ, 9
NO IN READ
GAL, USED
READ DATE Igt 04-k 23
METER RE -ISSUED? YES / NO
Issued by:
CHARGES:
METER MAINT
0- 1000 GAL 10.00
ADDITIONAL W ATER
REPAIRS -PARTS
TO AWL
Received by, GG��