HomeMy WebLinkAboutHYDRANT USE PERMIT - 22-00178 - Rexburg Waste Water Collections FHM 34Business name: &CL�a '
Picked up by:
Address:
DEPOSIT AMOUNT
$2,500 - 2" Water K
Do you want the dep
CONDITIONS OF P
To prevent possible c
desiring to obtain wa
1. Obtain a writt
2. Take water or
3. Check out the
hydrant agree
4. As indicated a
device will be
balance of the
5. The fee for an
Fee: 1
6. A $50.00 mair
maintenance (
7. The meter nr
same day per
Any person or entity
the normal charge fo
Date Issued: 9
METER OK:
❑YES
OUT F
IN RE)
GAL. (
READ
METEF
Issued by: -
Address:
35 North Is? East
Rexburo. ID 83440
FIRE HoYDRIANTAtUSERPE CUSTOMERS
Nooh.phetheonarexburg.org Phone:208.372-2136
Fax: 877.397,3917
www,rexburg.org
Date Issued S ZZ Meter # t
/�� Permit #
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Business name: y„ /
Picked up by Ster2!/ &16% K Phone # /�
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Year Issued:
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Hos er: A&a
Deposit amt: (Receipt Code= wD P) with credit cards charge a additional 3.5% (Receipt Code= MISCG)
$10800 - 2" Water Meter_ Deposit retained or refunded?
date)
S 800 - 1" Water Meter (
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 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 backfiow 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
to the normal charge for the water taken. S
1�
REFUND TO:
METER OK:
Sign
YES. UT READ 11YDr0'
NO IN READ
GAL. USED O
READ DATE
METER RE -ISSUED? YES/NO
Issued by:
be assessed a penalty charge of $400 in addition
CHARGES:
METER MAINT 75.00_
0- 1000 GAL 10.00
ADDITIONAL WATER
REPAIRS -PARTS
TOTAL
Received by: /�