HomeMy WebLinkAboutFIRE HYDRANT USE PERMIT 2 - 23-00192 - Western mountain FHM #5e� tea•
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER cUSTOMERS
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Amadmi Family Ca ""31y
Business name: 7�l/V u,ix�n M b1.Ln+hin G Phone- 77.oq
Picked up by 8� p,41J'!je Phone #
Address: `% 33 LA i � }� �t,rlr e L DLcit.AJI'am!
Year Issued:
Deposit amt- (Receipt Code= WDE Ith credit cards charge an additional 3.5/a Ukeceipt Code= M\SCG`
$1,800 - 2" Water Meter Deposit retained? or refunded? dated
$ Sao - 1" Water Meter �—
CONDITIONS OF PERMIT: inatio cit water system, any persons or ent\ty
in order to prevent possible contam n from backflow of the Rexburg Y Y
desiring to obtain water from a city fire hydrant must comply with the following: any watec.
1, obtain a written permit from Rexburg City Hall, 35 N 1 East, before attempting to take
2. Take water only from the one fire hydrant designated by the city water department.
3- Check out the back -flow 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. a to or loss of the device
4. As indicated above a deposit will be required on any metering device. Any damag acted , balance of the
will be paid for by the user. After any use, repair, or replacement charges are deducted 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— 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 assessed each 4eroc
maintenance on the meter.
�• 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 with this policy shall
to the normal charge for the water taken,
REFUND TO:
METER OK: YES
NO
OUT READ je
IN READ
GAL. USED —
READ DATE
METER RE -ISSUED?
Issued by: ol 4
YES / NO
be assessed a penalty charge of $400 in additiion
CHARGES;
METER M NMI
? 0_ 1000 GAL 10.00
ADD�TIONA�w A-CER
REP AIRS-P ARTS
TOT AL
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