TOWN OF WELLINGTON
8129 Third Street
PO Box 127
Wellington, CO 80549
(970) 568-0447
HYDRANT WATER METER PERMIT
DATE: PERMIT #: 20-HWM-
RESPONSIBLE PARTY NAME: __________________________________MOBILE PHONE: ________________________
COMPANY NAME: ___________________PHONE: ________________
MAILING ADDRESS: ____CITY: ST. ZIP CODE:
LOCATION
OF FIRE HYDRANT FOR USE: _____________________
________
PURPOSE FOR
USE WITH LOCATION: _____
PLANNED START DATE PLANNED FINISH DATE
THE TOWN MUST BE RECEIVE PERMIT APPLICATION AT LEAST 48 HOURS BEFORE THE PROJECT IS TO BEGIN.
ALL HYDRANT METERS WILL NEED AN APPOINTMENT TO RETRIEVE BEGINNING AND END METER READS, AS
WELL AS PROVIDE A TOWN OF WELLINGTON TAG TO AUTHORIZE THE USE OF THE METER.
THE TOWN CAN REVOKE PERMIT AT ANY TIME. PERMIT NOT TO EXCEED ONE YEAR AFTER ISSUANCE.
TOWN HYDRANT METER/WATER USE FEES:
• $3,
500 Deposit is required and will be held until the Hydrant Meter is returned in good condition. If a meter is inoperable or
damaged upon completion of use, the meter will be tested to determine how much of the deposit will be forfeited to cover repair.
• $10 p
er day charge + $15.20 minimum up to a 1,000 gallons
CONTRACTOR SUPPLIED HYDRANT METER/WATER USE FEES:
• $50 one time permit fee + $15.20 minimum up to a 1,000 gallons
THIS PERMIT HAS BEEN ISSUED TO THE ABOVE LISTED COMPANY/PERSON FOR USAGE WITHIN THE BOUNDARIES OF
THE TOWN OF WELLINGTON WITH THE FOLLOWING CONDITIONS:
1. Meter must be removed from the fire hydrant during non-working hours. All Town owned meters cannot leave Wellington Town
limits, and if you move job sites, please notify the Town staff via call or email.
2. Monthly meter reads will be conducted by a Town of Wellington employee on site in person and billed accordingly. No call in meter
reads will be accepted. Photographs of the meter serial # and current read will be accepted by email to:
jonesja@wellingtoncolorado.gov
3. Law Enforcement has been instructed to ticket anyone using water from a hydrant without an approved permit for theft of services.
I HEREBY AGREE TO THE CONDITIONS CONTAINED IN THIS PERMIT
SIGNATURE DATE
OFFICE USE ONLY
RECEIVED BY: APPROVED BY:________________________________
CHECK # FOR DEPOSIT: _________________________ HYDRANT SERIAL #:
BEGINNING METER READ: BEGINNING READ DATE:
END METER READ: END READ DATE:
TOTAL GALLONS USED: TOTAL AMOUNT BILLED:
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