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. �r <br /> O,�p�,O City of Orono , � ,�_��,������,� <br /> P.O.Box 66 � _ �� ^ �/ <br /> C 5 tal B1eyPazkway T�lataR�� ��,,����----���xt�#° �� ..� �a <br /> rys ay,MN 55323 <br /> ���� Phone:(952)249-4600 Fax: (952)249�616 "n����y����, �o��$ ���e� <br /> � <br /> CITY OF ORONO-LAWN SPRINKLER PERMIT <br /> Job Site Address: �.,�'�O �f�C� �,• <br /> Owner: p�t- `�D��-�- Telephone Number: � ��- J33Z <br /> Mailing Address: �a��� s prvc.�„ �, <br /> CitY: C��SA(� Zip: � <br /> Sprinkler Contractor: Qr��� ����e ephone Number: �S2- 7 2-�`fi t� <br /> Contact Person : �� License#: --� o b�`�l , P�o yg by• <br /> Mailing Address: �g�j�,' �Q� 5�� <br /> WATER SUPPLY <br /> Lake � Well❑ City❑ <br /> BACKFLOW DEVICE <br /> AVB ❑ PVB ❑ <br /> Make Model Year of Manufacture Quantity <br /> Sprinklers: <br /> � _u-w.�a.. �.p �� l(� --tc�t-� .��v ��� <br /> HYDRALTLIC CALCULATIONS Design Data: � <br /> Area of Application: - Sq. Ft. B <br /> Coverage per Sprinkler: � Sq. Ft. <br /> No. of Sprinklers: 2 <br /> Total Water Required: GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee: $ 35.00 <br /> 2. State Surcharge $ 5.00 <br /> 3. Mail-In Fee $ 2.00 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) <br /> $ <br /> The undersigned hereby applies to the City of issuance of a Sprinkler System Permit, agrees to do <br /> all work in strict accordance with the ordinances of the City and State regulations, and certifies <br /> that all statements made on this app 'cation are complete, true and correct. <br /> Applicant ��J Date ���" �� <br /> ......................................... ..............................pp............................................................................................................................................. <br /> Approved A roved with Corrections Denied <br /> 5��� � �o� ►v <br /> Reviewed By: �� Date <br /> d <br />