Application for Temporary Use of a Fire Hydrant

Applicant Information

Name*

Company (if applicable)

Billing Address*

Street Address City State ZIP Code

Phone*

Email*

Tank Size

In Gallons

Meter Size

In Inches

Start Date*

End Date*

Location of hydrant(s) to be used*

Please be specific (i.e. at intersection of Broad and Main St next to water fountain in front of 101 W. Broad St).

Hose and fittings to be disconnected from fire hydrant(s) at all times except when they are actually being used.
Permission must be obtained from the DOT to lay hose in public space.
Approved stationary air gap must be included in direct hose or pipe connection

By submitting this application, I affirm that the information provided is correct and that I have read and understood the above conditions.

Name*

First Last