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,, <br /> �`�c'� c�`' '-''"���' �- ' ' � � �/ � <br /> , , , _ �_ �-7- �� <br /> _ � v ; , <br /> ._� <br /> � Please check one: New `�� Addition <br /> Jos srrE ���.C�� �� <br /> _ `. <br /> Owner's Name ;�� �% �/'`� �',��J�✓ �� Telephone Number �/�. u� '�� --`���� � <br /> , <br /> � Mailing Address �_ � ,���T�'��'�. ;,� ��/'�;�_�� ;�� �r;,,,J 'e- � <br /> Sprinkler Contracto�s Name_��(�� �f'��� �� �,'�''� TelephoneNumber `'` �---' -�� �� " `� �- �'` �� <br /> Contact Person ��"�.�, '��� ��� t. ��� �� <br /> Mailing Address /D � � � "/` /(''��t- �. ���j^�r�cl/`�>�, �/�J• . <br /> `VAT'ER SUPPLY <br /> Lake Well ��� City <br /> BACKFLO`V DEVICE / - <br /> AVB P VB �J <br /> � Year of <br /> Make Model Manufacture uanti <br /> Sprinklers /�J�<.iorJ /�rc� ������ ��, ,s ; ��.s_. <br /> /��%`� � � l�,.r yo� �u6 , F� <br /> TOTAL %S��-� <br /> HYDRAULIC CALCITLATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coveraje per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: Gp� <br /> PERI�IIT FEE CALCULATION <br /> 1. Permit Fee $ 3 5.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERitiIIT FEE (Add lines 1-3 above) $ <br /> The undersi?ned hereby applies to the City for issuance of a Sprinkler System Pernut, a�rees to do <br /> all�vork in strict accordance with the ordinances of the City and State regulations, and certifies that <br /> all statements made on this application are complete, true and correct. <br /> �: <br /> Applicant '✓ ���e� Date ��-� �� `� � l <br /> *************************�**************�*************�***********�***�*********� <br /> Approved Approved with Corrections Denied <br /> Reviewed by: __ � � , <br /> � � � � Date . -� � � <br />