HomeMy WebLinkAboutHYDRANT USE PERMIT 2 - 22-00934 - KM Services-FHM #2433 North IIf Fail
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ft Data Issued
FIRE HYDRANT USE PERMIT
N0 NIRADiIIUNAI WATER CUSTOMERS
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Phone: 20a,312-213G
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Meter 0 Hoge Number:
Permit If
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Address:
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Year Issued: ?aft
Deposit omt: (Receipt Code■ WD )with credit cards charge an dditlonal 3.S% (Receipt Codex MIKA)
$1,800 - 2" Water Meter _7 Deposit retained? _ car refunded?
$ 800 - i" Water Meter ( date)
CONDITIONS OF PERMIT:
In order to prevent possible contamination from backffow of the Rexburg city water system, any persons or anthy
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 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 backfktw and metering device from the city water dept. to be attached to the fire hydrant
agreed upon by the user and the city water daptment,
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.)
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 ssessed each year for
maintenance on the meter.
/ The meter needs to be returned by 12/1 for testing calibrations, A meter can be reissued the some day per
request if needed.
Any person or
entity not
complying
with this policy
shall be
to the normal
charge for
the water
taken. (,Cmw�a
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a penalty charge of $400 In addition
s
REFUND TO:
METER OK: YES OUT READ CHARGES:
NO IN READ METER MAINT 75,00
GAL. USED / n 0- 1000 GAL 10.00
READ DATE . 2.? tZecl ADDITIONAL WATER _
iVA15r✓ METER RE -ISSUED? NO REPAIRS -PARTS
TOTAL
Issued by: Received by: J�
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