HomeMy WebLinkAboutHYDRANT USE PERMIT - 23-00133 - Rexburg Parks FHM 28 (2)oY `eeeua� iJ
FIRE HYDRANT USE PERMITCITY OF
NONTRADITIONAL WATER CUSTOMERS ,o
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Phone: 208.372-2136 Arnerimi Family Camnwndy
www.rexburg.org North 1st East Noah.phefhrexburg.org
Rexburg, ID 83440 ww.rexburg.org Fax: 877.397.3917 ''
Date Issued l Z3 Meter# F *2 Hose Number:_
Permit # �VS-
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Year Issued:
FIF Deposit amt: (Receipt Code= WDEP) with credit cards charge an additional 3.5% (Receipt Code= MISCG)
$1,800 - 2" Water Meter (Z Deposit retained? or refunded?
$ 800 - 1" Water Meter ( date)
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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 111 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 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 be assessed a penalty charge of $400 in addition
to the normal charge for the water taken.
Signature f Applicant
REFUND TO:
METER OK:
Issued by:
Date Issued: 1
YES OUT READ
NO _ IN READ
GAL. USED
READ DATE
METER RE -ISSUED? YES / NO
CHARGES:
METER MAINT 75.00
0- 1000 GAL 10.00
ADDITIONAL WATER
REPAIRS -PARTS
TOTA'kL
Received by: