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, <br /> � `"��" City of Orono ��. ���� FO C Y USE ONLY <br /> �' ¢ � P.O.Box 66 �(/ <br /> ��� _ ���� z�so Keuey pa�k.,�ay ��' // � /�--� �(�/ 2— '!/02� <br /> Date Received: Permit tt <br /> � �`� �'= �� Crystal Bay,MN 55323 <br /> ��, �.t�;�, �':', <br /> � <�,?�r��� Phone:(952)249-4600 Fa�c: (952)249-4616 Approved By: Amount$: <br /> ��!!rs�vl��,. <br /> CITY OF ORONO—LAWN SPRINKLER PERMIT <br /> PERMIT CODES(IN-HOUSE) <br /> Sprinkler/Residential/Lawn Spnnkler/Blank <br /> Spnnkler/Residential/Backflow Device OnlyBlank <br /> Please Check One: New Addition❑ <br /> Job Site Address: ��� ' �- 1� � .5��� , <br /> Owner: �� c��- �� ' l,,��/�` � Telephone Number: ���_� � ��� ��/ <br /> Mailing Address: _ )�� ___1� P� � <br /> � � <br /> City: ' L Zip: `7� �D� <br /> �I�l% r Contractor: � o"�, OC � � N'�/���elephone Number:�l�- ���5�� <br /> ���a�C-�e � ' � <br /> Contact Person : '/L License#: <br /> Mailing Address: <br /> ) - �� , � � <br /> WATER SUPPLY <br /> Lake ❑ Well ❑ City ❑ <br /> BACKFLOW DEVICE <br /> AVB ❑ PVB ❑ �� <br /> �---� , <br /> Make ,, �(� Model � Year of Manufacture Quantity <br /> Sprinklers: <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Tetal Water Requi:ed: GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee: $ 50.00 <br /> 2. State Surcharge $ 5.00 <br /> 3. Mail-In Fee $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add lines 1-3 above) $�(� <br /> The undersigned hereby applies to the City of issuance of a Sprinkler System Permit, agrees to <br /> do all work in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all statements made on this application are complete, true and correct. <br /> Applicant Date <br /> .............................................................................................................................................................................................................................. <br /> Approved Approved with Corrections Denied <br /> Reviewed By: Date <br /> Reset Form <br />