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�0 City of Orono FOR CI Y USE ONLY <br /> P.O.Box 66 j t <br /> 2750 Kelley Parkway Date Received: F lU Permit# C�01 0 9 7 <br /> Crystal Bay,MN 55323 <br /> t <br /> Phone:(952)249-4600 Fax: (952)249-4616 <br /> 'Approved By: Amount$: <br /> CITY OF ORONO-LAWN SPRINKLER PERMIT <br /> Al <br /> Lam" <br /> 1 <br /> ca, d8: a ',�a,: ' Y,...:, - u.�a F4^r. ,tom i of .,�.' h' <br /> Job Site Address: <br /> Owner: : Uk <br /> Telephone X _ L <br /> 1 <br /> Mailing Address: <br /> City: �� �����/ Zip: �3,107 <br /> Sprinkler Contractor: s ©Hj Telephone Nu er: �J��- 3 ' <br /> Contact Person : ,Qyh C License <br /> Mailing Address: oX 4 <br /> WATER SUPPLY <br /> Lake ElWell X City F-1BACKFLOW DEVICE <br /> AVB PVB ❑ <br /> Make c p Model / /r Year of Manufacture -20/O Quantity--L— <br /> Sprinklers: <br /> uantityTSprinklers: <br /> 'Ile, <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: /i;OC90 Sq. Ft. <br /> Coverage per Sprinkler: /P'DO Sq. Ft. <br /> No. of Sprinklers: /06 <br /> Total Water Required: /6", 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 /> $_ _AD <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 o this ap ion are complete, true and correct. <br /> ApplicantDate <br /> ................................................................................................................................ <br /> Approved Approved with Corrections Denied <br /> Reviewed By: 14 ) �a _a2LDate � �� <br />