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. <br /> . � <br /> , y � ¢�A` City of Orono FOR ITY USE ONLY <br /> O `�O P.O.Box 66 � �J <br /> 2750 Kelley Parkway Date Received: �� Permit# ��1�� / <br /> ':�,� 11��' - ,{���� Crystal Bay,MN 55323 <br /> • ? � �'�'r4i�`,i Phone:(952)249-4600 Fax: (952)249-4616 Approved By: Amount$: <br /> � <br /> �kaaxo <br /> CITY OF ORONO—LAWN SPRINKLER PERMIT <br /> Please Check One: New Addition ❑ <br /> Job Site Address: � �� �� � r� � (� � �j\T , <br /> Owner: �r'������c���/ Telephone Number: � `� 2' ��5� �a�� <br /> n s-�_ <br /> Mailing Address: � C 'rJ �J V�O Q12 <br /> City: ��1 l/I � U1'�0./ C Zip: ���� � <br /> Sprinkler Contractor: �JY 1 �16-� (l�le'��/lU� 1'1l �elephone Number: (g S I" �3� `��-j L� <br /> Contact Person : �'�G�(�l,�r-C�. �`'� �� License#: (���' ��� -' {� � <br /> Mailing Address: �j ��� � �r r(�,C� S•'�', �Y 2 S c c?t fi j,,� '�i. � �'��-� <br /> WATER SUPPLY / <br /> Lake❑ Well❑ City �t�� <br /> BACKFLOW DEVICE <br /> AVB ❑ PVB <br /> t <br /> Make �`K p�5 Model ����� Year of Manufacture 2v�U Quantity <br /> Sprinklers: <br /> HYDRAULIC CALCULATIONS Design Data: �,� c���j <br /> Area of Application: t4z �_`�- Sq. Ft. ���„ <br /> Coverage per Sprinkler: 3 %� =,p �q sa. Ft. �� �R�Np <br /> No. of Sprinklers: 3�i CI� <br /> Total Water Required: g (,�Q yY1 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) $ Z� �� <br /> The undersigned hereby applies to the City of issuance of a Sprinkler System Permit, agrees to <br /> do all work in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all statements made p� this application are complete,true and correct. <br /> . � <br /> Applicant � rt ~n Date��_ <br /> ...................................................................................................•-•--................................................................................................................. <br /> Approved , Approved with Corrections Denied <br /> Reviewed By: ;'i',.✓".'.:�!�i,- - Date �'-�'" �� <br /> Reset Form <br /> `'�a.c.�c._� �—�j �. �.� ��� — � � <br /> l �, <br />