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. � ;:� ���� <br /> 1 _ 4� <br /> / <br /> Please check one: New Addition � <br /> JOB SITE I Z� S �I�'U�:c�Nt� �►�.'. . <br /> Owner's Name Kenneth H. DeHoff, Jr. Telephone Number J r �,�,% '3 <br /> — 1205 Shoreline Drive <br /> Mailing Address_ Wayzata, MN 55391 <br /> khdehoff@aol.com <br /> Sprinkler Contrac�u► , �vame TelephoneNumber <br /> Contact Person �"G��" ��)��� �oi RJ�� T�� ��,,�D�� <br /> Mailing Address � <br /> `VATER SUPPLY ' � .. <br /> Lake_� we11 City ��pR 0 8 1999 <br /> BACKFLOW DEVICE <br /> _ � AVB� �._____.E..� _:�a���a �.. ....,�..:.;;� <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: _,�..Sc�,...��' <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 37 o c� <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees to do <br /> all work in st ' accor�ance with the ordinances of the City and State regulations, and certifies that <br /> all statemen s ma e o th' application are complete, true and correct. <br /> ;� <br /> Applicant Date� �r /� <br /> ******************** ************************************************************ <br /> Approved Approved with Corrections Denied <br /> Reviewed by: �7���� <br /> Date <br />