TEMPORARY HYDRANT WATER PERMIT APPLICATION

2. Type of Hydrant Meter Permit Request*

   Please select if the hydrant meter will be used for construction purposes or a temporary potable hydrant connection for a special event (ex. concert, drinking water).

   1. Hydrant Construction Water
   2. Renewal of Existing Hydrant Construction Water Permit
   3. Temporary Potable Hydrant Connection
4. Company Name *

5. Company Phone Number*

6. Email Address*

8. Billing Address *

9. City*

10. State*

11. Zip Code*

13. Physical Address*

14. City*

15. State*

16. Zip Code*

20. Purpose of Water Usage (i.e. backfill,dust control etc):*

21. Physical location where water will be used:*

23. Physical location where water will be drawn (specify hydrant location):*

24. Average water usage per month:*

25. Time frame needed for the hydrant meter*
    Time frame needed for the hydrant meter Start Date

    —

    Time frame needed for the hydrant meter End Date

27. If your project is going to be done in phases, provide us with your project phasing time line.

29. Once your approved permit has expired you must return the Districts equipment for a final calibration of the meter and backflow device.

33. Meter contact person *

34. Contact Phone Number*

35. Email Address*

37. Please understanding that by filling out this permit application does not mean that there will be a hydrant meter available right away. Please check yes, that you understand. *

    1. Yes

38. Date and time needing to pick device*
    Date and time needing to pick device

    Date and time needing to pick device

40. By submitting this application, I affirm that the facts set forth in it are true and complete

42. Name:*

43. Date *

45. Signature upon picking up device

Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field