HomeMy WebLinkAboutFIRE HYDRANT PERMIT 2 - 23-00205 - Jerome Bowen FHM #35fIR! HYDRANT USE PERMIT
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Year Issued: — -
DeppsA amt: (Receipt Code= WDEP with credit cards charge an additional 3,596 (Receipt Code= MISCG)
$1 Sp0 2• Water Meter _— ' Deposit retained? or refunded? (date)
S wo - 1' Water Meter
COMTION$ OF HERMIT: persons or entity
in order to prevent possible contamination from bacldlow of the Rexburgcity water system. any
desinn to obtain taster from a crh fire hydrant must comply with the following:
1 Obtain a,►,ritten permit from Rexburg City Ha11. 35 N 1`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 backffow 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 d
wiYt be paid for by the user. After any use, repair, or replacement charges are deducted ,the balance
depos* wil 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
{� A SWW 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 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 yie�this policyshall be assessed a penalty charge of S400 in addition
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to the normal charge for the at 1 ni llA r�^i
Signat of
REFUND TO:
METER OK YES OUT READ 1,419.
NO IN READ S
GAL USED IY�f ya
READ DATE
METER REASSUED? YES/NO
Issued tri- e
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CHARGES:
METER MAINT
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
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Received by:
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75.00
10.00