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. � <br /> . � 3 � � � <br /> � <br /> Please check one: New ✓ Addition / <br /> JOB SITE����C� , ,�,�I;�.� �,� <br /> Owner's Name�,�� � _��� TelephoneNumber_�/.^�;��� <br /> Mailing Address�?J c� C� ��t:�,� ���,. � C��,`���� n.� �-v 5"-�� / <br /> Sprinkler Contractor's Name�,���„ � e,, ,j -7-�,r- Telephone Number �� _v< < � <br /> Contact Perso f i �.�-�.�- Z �L ,�� <br /> Mailin;Address_�__� �i�v �1,� :�-e l--E�.� � 5 �✓- � �S� , ,�-r�v sS'���� ' <br /> `VATER SUPPLY <br /> Lake 1 Well City <br /> BACKFLO`V DEVICE - <br /> AVB :� P VB <br /> � Year of <br /> Make Model Manufacture uanti <br /> Sprinklers �a:,.� b�.a �1� �6l ���7�i> '�-� <br /> � � � TOTAL 3�; <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: �„��,_.;;� � ,, �,.�j Sq. Ft. <br /> Covera�e per Sprinkler: 3S��- �3 -�G �� Sq. Ft. <br /> No. of Sprinklers: '�,� ��,�,-,.t, k ;�� ��,,�,T� <br /> Total Water Required: r�� GPti1 <br /> PERII�IIT FEE CALCULATION <br /> 1. Permit F�e $ 35.00 <br /> 2. State Surchar�e � .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERitiIIT FEE (Add lines 1-3 above) $ <br /> The undersi�ned hereby applies to the City for issuance of a Sprinkler System Pernut, agrees to do <br /> all�vork in strict accordance with the ordinances of the City and State regulations, and certifies that <br /> all statements made on this application are complete, true and correct. <br /> App �_ant _ Date—l�l���7 <br /> �� <br /> ****** ***** * �************ **�**************************�*****************� <br /> Approved Approved with Corrections Denied <br /> Reviewed by: ^ , <br /> ,�c''9 - �GG�,� Date �(�-/�r��J <br />