Fire Hydrant Application

Fire Hydrant Application - Water Tank
Form Description:
This form is an application for renting a fire hydrant meter from the City of Asheville, outlining the required deposits, service fees, and the specific locations for pick-up and return. It also establishes strict operational and maintenance mandates, including the requirement to email weekly usage.

Applicant Information
Applicant
Application Date

MonthDayYear
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
FID / SSN
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Contact Name for Deposit

First NameLast Name
Contact Number for Deposit
Please enter a valid phone number.Format: (000) 000-0000.

Deposit and Tank Information
Service Charge: $1000 deposit, initial $50 service charge, and $50 monthly until account is closed.
NCDOT#
Enter 'NA' if you are using a trailer water tank.
Tank Size (Gallons)
Please use Gallons
Total Fees Due
When no longer needed you must contact the city to close your account and avoid additional fees.

Tank to Hydrant Policy and Fees
- Customer must email backflowmailbox@ashevillenc.gov each week with the number of times the tank was filled.
- Customer must email no later than the last business day of each week. Failure to do so will result in a $200 charge for 1st violation, $500 charge for second violation, third violation: forfeit of access to hydrant and deposit.
- A $15.00 delinquent fee will be assessed to any account not paid on or before the due date.
- A $50.00 second delinquent fee will be assessed to any account with an unpaid balance fifteen (15) days after the due date.
I have read and agree with the above information

Declaration
I certify that I have read, agree with, and have been provided the terms and conditions of this application. The information provided on this form is true, complete, and accurate to the best of my knowledge. By checking this box and typing my full name below, I am providing my electronic signature.
Full Legal Name
(Required for Signature)
Date Signed

MonthDayYear
Should be Empty:

Fire Hydrant Application - Water Tank