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• City of Orono FOR CITY USE ONLY <br /> �V \ P.O.Box 66 <br /> 2750 Kelley Parkway Date Received: ! Permit#0�* �3 <br /> MN <br /> PhoneCrystal:(952)ay249 460055323 Fax <br /> (952)249-4616 Approved By: Amount$: c:›2 <br /> CITY OF ORONO—LAWN SPRINKLER PERMIT <br /> PERMIT CODES(IN-HOUSE) <br /> Sprinkler/Residential/Lawn Sprinkler/Blank <br /> Sprinkler/ResideentialBackflow Device Only/Blank <br /> A:Fq€ ciao �v d <br /> ., s � »"" ,� .�r - � <br /> Job Site Address: -S \>•i-e f.c `-a n (\) <br /> Owner: >(-hC),k) &AC rr r Telephone Number: (o\Z-%Q I-Z33 <br /> Mailing Address: atz.0 )-Gra <br /> City: \-%Q Zip: <br /> Sprinkler Contractor: � c'r% 1a� ,15,er\4 elephone Number: 6\ Z 27 0 147)25 <br /> Contact Person : T, OCC0 v,� 1' , License#: <br /> Mailing Address: <br /> WATER SUPPLY <br /> Lake n Well n City❑ <br /> BACKFLOW DEVICE <br /> AVB n PVB ns+0,\\a.,.S, 0 up^ate' <br /> Make 0- Model 7 [0, A Year of Manufacture 2.01) Quantity I <br /> Sprinklers: <br /> HYDRAULIC CALCULATIONS Desi2n Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: 6D <br /> Total Water Required: ( 0 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 /> 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 application are complete, true and correct. <br /> Applicant Date 9/ZO/ <br /> Approved Q Approved with Corrections Denied <br /> 4145/`- <br /> Reviewed By: / :t. Date q � -1 1 <br />