Laserfiche WebLink
///� G�' f <br /> �,t��¢�a i City of Orono I' � �jV`� FOR Ct Y USE ONLY <br /> l� <br /> p P.O.Box 66 a ,, � 9 <br /> �t � . ?' 2750 Kelley Parkway Date Received:����-�Permit# ���i`�� a�-3 <br /> � �� Crystal Bay,MN 55323 <br /> '��,���_�� �.��� <br /> �����r�"�t•��, Phone:(952)249-4600 Fax: (952)249-4616 Approved By: Amount$: <br /> ��'ssxn�% <br /> CITY OF ORONO–LAWN SPRINKLER PERMIT <br /> PERMIT CODES(IN-HOUSE) <br /> Sprinkler/Residential/Lawn Sprinkler/Blank <br /> SprinkledResidential/Backflow Device Only,Blank <br /> Please Check One: New Addition <br /> Job Site Address: �j�� ���� -��/�� ��,�� <br /> Owner: � c..�� C71/lq ��Q/'L �— Telephone Number: �(P �-� r�"�`'�-�7/ <br /> Mailing Address:,�L _S - �7�j � �. �. <br /> City: Y U J Zip: `7���(J�� <br /> ��y;l����er Contractor:� Telephone Number: (�pJ .�9�'�'j3 I <br /> Contact Person : � License#: 0����}�(1/� <br /> Mailing Address: �7�j� � � rj . ������� 1'y�� ������j <br /> WATER SUPPLY <br /> Lake ❑ Well ❑ City ❑ <br /> BACKFLOW DEVICE ���� <br /> AVB ❑ PVB ❑ <br /> '�"_ c_ <br /> Make � ' �� Model 6ar'J 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 �'Vater ReGuired: 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 ]-3 above) $��,y)� <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� tements made on this application are complete, true and correct. <br /> i <br /> Applicant ��� Date �� 3 � <br /> Approved Approved with Corrections Denied <br /> Reviewed By: Date <br /> Reset Form <br />