HomeMy WebLinkAboutHYDRANT USE PERMIT - 23-00634 - B JACKSON Construction FHM #20FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
35 North Ist East Nooh.phetheon®rexburg.prg
Rexburg. 10 83440
www.rexbLwg.org
Date Issued E, ii�
Phone:208.372-2136
Fox: 877.397.3917
IIIIII
Meter R
nuslness name: q Td'kC r t Permit I
Picked up b
Address: / PL),ja � ,
c1TP of
REX BURG
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Amr'n,ni rnmrA• CommLnir,
Hose Number:_
Phone #1( oy_
Phone ---
City State Zip: (1 —� Loeatf;om ��e'
Deposit amt: (Receipt Code= Wp -- Year Issued: h> 2
$20500 - 2" Water MeterI pt Code= with credit cards charge an additional 3.596 (Receipt
$ 800 - 1" Water Meter _ Deposit retained? MISCG)
or refunded?
CONDITIONS OF PERMIT
In order to prevent (date)
desiring possible contamination from g to obtain water from a c backflow of the Rexburg city
wi water system, any persons or entity
written permit from RexburgP Y with the following:
2 Take water only from City Hall, 35 N 1" East, before attempting
3 Y the one fire hydrant designated b tto take an Check out the backflow Y the cif Y water
and metering device from the cityY water department.
agreed upon by the user and the city water de water dept. to be attached to the fire h
4. As indicated above a ria..,,..: _ „ . Ptment. hydrant
S.
\� 6.
J �I 7
\ v
l r ~
will be - - --^• "r'equired on any metering device. An
Paid for by the user. After any use, repair, or replacement y damage
deposit will be refunded to the user. (City water dept. will conduct a final ins ge to or loss of the device
The fee for any water obtained through the metering device is as follows: are deducted ,the balance of the
Fee: 1 — inspection.)
1,000 gallons $10.00 Each 11000 : $
A $50.00 maintenance fee for 1" and 7 gallons thereafter
.00
maintenance on the meter. $ 5.00 maintenance fee for 2" $5
will be assessed each year for
The meter needs to be returned by 1211 for testing calibrations. q
request if needed.
will
can be reissued Any Person or entitthe same day per
y not complying with this
VP to the normal charge for the water taken, policy shall be assessed a
\�\ penalty charge of $q� in addition
CHARGES:
GAL. USED _ Z C METER
MAINT
READ DATE 40� 0- 1000 GAL
METER RE -ISSUED? yEs ADDITIONAL 10.00
"'� REPAIRS -PARTS
Issued by: -
Received by: TOTA
�rgnature of
REFUND T0:
METER OK: YES
N0� OUT READ05
IN READ , Q e Z