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0 ?City of Orono FOR CI Y USE ONLY <br /> g P.O.Box 66 A9 <br /> 2750 Kelley Parkway Date Received: Permit# J <br /> Crystal Bay,MN 55323 SO <br /> Phone:(952)249-4600 Fax: (952)249-4616 Approved By: �P Amount <br /> yF /pA <br /> l� <br /> CITY OF ORONO-LAWN SPRINKLER PERMIT <br /> 'FES H O¢� <br /> PERMIT CODES(IN-HOUSE) <br /> Sprinkler/Residential/Lawn Sprinkler/Blank <br /> Sprinkler/Residential/Backflow Device Only/Blank <br /> Please Check One: New Addition <br /> Job Site Address: L L v vj w °�.2, T t .� <br /> Owner: ��E-L Telephone Number: (` 3.Z S�Z Ll <br /> Mailing Address: I <br /> City: ` Zip: IN <br /> Sprinkler Contractor:_w 4*- Telephone Number: r1 S-L X17 1 V <br /> Contact Person: License#: Cf Vii'u <br /> Mailing Address: gam, Z Z La-1c �. ��, M N Ste-? S <br /> WATER SUPPLY <br /> Lake ❑ Well❑ cityl� <br /> BACKFLOW DEVICE <br /> AVB ❑ PVB ❑ <br /> Make � Model 1' Year of Manufacture 2- Quantity <br /> Sprinklers: <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: �; t 1--��" Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: \ S GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee: $ 50.00 <br /> 2. State Surcharge $ 1.00 <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 L Date -L I1 <br /> ......................................... ................................................................................................................................................................................... <br /> Approved Appro with Corrections Denied <br /> Reviewed By: 4e <br /> Date to <br />