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�� � City of Orono � ��� FO CIT USE OhLY <br /> � Qb .t'�t. <br /> {„�� a'.; P.O.Box 66 �A/ �1 <br /> �� � 4� 2750 Kelley Parkway //��VV Date Received/� � rmit# �!/� � � <br /> 'i � �" � ��� Crystal Bay,MN 55323 v <br /> t�� �6"�r�'�i^���� Phone: 952 249-4600 Fax: 952 249-4616 <br /> ��` ���, ��/i � ) ( ) Approved By: Amount$: <br /> .�zatic.,:� <br /> CITY OF ORONO–LAWN SPRINKLER PERMIT <br /> PERMIT CODES(IN-HOUSE) <br /> Spnnkler/Residential/Lawn Sprinkler/Blank <br /> Spnnkler�Resideotia]/Backflow Device OnlyBlank <br /> �'lease Cheek One: New[� Addition �. � �� <br /> i <br /> Job Site Address: � � 5�'1� , � ���j� <br /> Owner: wL> ��. c�j(/l� L�y'l� �/'— Telephone Number: ��0.�-�"��-�7� <br /> Mailing Address: � � Sj�' — ��7� �� f <br /> City: ✓� �- Zip: `�'��D� <br /> ��'�:���er Contractar: � /� �Telephone Number: (p�oZ`��-r753� � <br /> � 5 <br /> Contact Person : i/� License#: � � aC�C`� ,"�'� <br /> Mailing Address: �`7� � � �� S )'j'���J �/�,�� �=g�� <br /> WATER SUPPLY <br /> Lake ❑ Well ❑ City ❑ <br /> BACKFLOW DEVICE �� <br /> AVB ❑ PVB ❑ � <br /> Make��(C Model g�5 1 Year of Manufacture Quantity <br /> �rinklers: <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: 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 l-3 above) $ ��Op <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 statei�ents made on this application are complete, true and correct. <br /> Applicant � Date �� �) �2-- <br /> Approved Approved with Corrections Denied <br /> Reviewed By: Date <br /> Reset Fo�m <br />