HomeMy WebLinkAboutHYDRANT USE PERMIT - 23-00805 - Mountain West Electric FHM 33 (2)�® crust our People. crust our Data. wwcon,r
energylab. co
35 North Ist East
Rexburg, ID 83440
Noah.phethean®rexburg.org Phone:208.372-2136
www.rexburg.org Fax:877.397.3917
+• ! America's Family communily
LABORATORY AN N
Prepared by Bill 9 Date
Meter #
Permit #
Hose Numoei
nt City of Rexburg ,
act: ID7330022 Phone #
D: 624062335-001 Business name: -�-'i k
sample ID: 980 Westwood Drive ��,C v.�,, Phone #
Picked up by: 6
/ 2 d Lvr.XNDns
Result units Qu. Address:
refer[ Y3��2f Yearlssued: 023
TOTAL City State Zip:k
0.008 mg/L
ND mg/L Deposit amt: (Receipt Code= WDEP ith credit cards charge an ad oiflrefunded?(Receip de= MISCG
$2,500 - 2" Water Meter
Deposit retained. ( date)
$ 800 - 1" Water Meter
CONDITIONS OF PERMIT:Icw of Rexburg y y ersons or entity
In order to prevent possible contaminath hydrant t Mustfrom Complywith the following ter system, any p
desiring to obtain water from a city fire by st East, before attempting to take any water.
1. Obtain a written permit from Rexburg
dr City
nt designated by the city water department.
2. Take water only from the one fire by
3. Check out 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
the user. After any use, repair, or replacement charges are deducted ,the balance
will be paid for by ?�
deposit will be refunded to the user. (City water dept. will conduct a final inspections (� / fin/ Pi
5. The fee for any water obtained through the metering device is as follows: G "U
Fee: 1-1,000 gallons $10.00 Each 1,000 gallons thereafter : $5.00
e for 2" will b� assessed each year for
6. A $50.00 maintenance fee for 1" and $75.00 maintenance fe
maintenance on the meter.
testing calibrations. A meter can be reissued the same ay per
7. The meter needs to be returned by 12/1 for
request if needed.
olic shall be assessed a penalty charge of $400 in addition
Any person or entity not complying with this p Y
to the normal charge for the water taken.
Signature of Applicant
offing Limit
itrot Limit
REFUND TO: CHARGES:
YES __ OUT READ r 3 3 I Z
METER OK: IN READ METER MAINT 10.1 0
NO 0-1000 GAL
GAL. USED ADDITIONALWATER
READ DATE REPAIRS -PARTS
METER RE -ISSUED? YES / NO TOTA
Received by:
Issued by: