H2GO Brunswick Regional Water & Sewer

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Fire Hydrant Meter Application

APPLICATION TO USE FIRE HYDRANT

Company Name:

Phone Number:

Address:

City/State/Zip:

Contact Name:

Contact Phone:

Date To Be Installed:

Estimated Time Needed:

Location of Hydrant:

Charges Will Be As Follows:

Meter Size	Security Deposit	Hook-Up Fee	Admin Fee	Avail. Fee Per Day	Water Rate Per 1000gals.
3/4"-3"	$1000	$50	$25	$15	$4.00

* NON REFUNDABLE FEE

**Security Deposits are refundable minus usage and rental fees if there is no damage to the hydrant meter or damage to the hydrant. Damages will be assessed according to severity. The customer is responsible should the hydrant meter be stolen. The customer is responsible for all charges not covered by security deposits.

If the rental is longer than one month, the meter may be read and billed monthly for the rental amount of usage.

The hydrant meter will be installed and disconnected by H2GO personnel only. Customer may not remove hydrant meter from the above location and connect at another location. Customers will give 48 hours (2 working days) notice of disconnection

Use only a certified hydrant wrench when opening the hydrant.

Signature:

Date:

Meter #:

Receipt #:

Date:

Date Installed:

Installed By:

Meter Read:

Date Removed:

Removed By:

Meter Read:

Any Damages:

Daily Rental:

Usage:

Total Charges:

New Account #:

Initial Setup:

Date: