HomeMy WebLinkAboutHYDRANT USE PERMIT - 23-00316 - We R Self Storage FHM 12CO
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35 North Isf East
Rexburg, ID 834AO
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
Noah.phethean@rexburg.org
Phone:208.372-2136
www.rexburg.org
Fax:
877.397.3917
CITY OF
REXBURG
Amerirws Lr+mily Community
Date Issued 3 Z3 Meter# Hose Number:
��% Permit #
Business name: �Vn 12 51 �(O�P Phone #
Picked up by Phone # 99
Address:�� l oca¢ion.a•el li" sA
RIj"r-�,1 q0 Year Issued: `7S
Deposit amt: (Receipt Code= WD ) with credit cards charge an additional 3.5% (Rec Code= MISCG)
$1,800 - 2" Water Meter Deposit retained? or refunded? =
$ 800 - 1" Water Meter (date)
CONDITIONS OF PERMIT:
In order to prevent possible contamination from backflow of the Rexburg city water system, any persons or entity
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 Vt East, before attempting to take any water.
2. Take water only from the one fire hydrant designated by the city water department.
3. Checkout 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.)
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 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 with this policy shall b� assessed a penalty charge of $400 in addition
to the normal charge for the water taker).\ 1 1 1 8 // //
REFUND TO:
METER OK:
"✓ 5i jd tgr� bf Applicant
YES OUT READ
NO INREAD i
GAL. USED
READ DATE
METER RE -ISSUED? YES/NO
Issued by:
.f
CHARGES:
METER MAINT
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
7S.00
10.00
TOT.. � .
Received by:
. II'W!�
Phone # (go 50 2.1�2-
-year Issued: 2=6 g
,e an additional 3.5% IReceip de= MISCG)
or refunded?
I date)
the Rexburg city water system, any persons or enGt
with the following:
1 I" East, before attempting to take any water.
ed by the city water department.
the city water dept. to be attached to the fire hydra
tent.
my metering device. Any damage to or loss of the d
or replacement charges are deducted ,the balance
dept. will conduct a final inspection.) ,
tering device is as follows: I e
,000 gallons thereafter : $5.00
laintenance fee for T' will be assessed each year fr
sting calibrations. A meter can be reissued the sat
_y shall be assessed a penalty charge of $40C
ire of Applicant
_ CHARGES:
METER MAINT
0- 1000 GAL 10
ADDITIONAL W ATER
REPAIRS -PARTS _
IOTA
Received by:
4 P416 43� /A.<&