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0¢p�� P o Bof�Orono FOR CITY USE ONLY <br /> 2750 Kelley Parkway Date Received: Permit# <br /> r� �?�'�• �." Crystal Bay,MN 55323 <br /> �\ "���.►`���/� Phone: 952 249-4600 Faac: 952 249-4616 <br /> \�t�o�� <br /> ( ) � ) Approved By: Amount$: <br /> CITY OF ORONO-LAWN SPRINKLER PERMIT <br /> PERMIT CODES(IN-HOUSE) <br /> Sprinkler/Residential/Lawn Spnnkler/Blank <br /> Spnnkler/ResidentialBackflow Device OnlyBlank <br /> Please Check One: New Addition <br /> Job Site Address: �S`�1�C; �h��c�y �(������%�. , ��.�;�-��, ;v�,,� <br /> Owner: ��v:� �h .�.\'c Z Telephone Number: c�,�. -1�U +-{ t�,S c� <br /> Mailing Address: .S A t�E <br /> City: ���o•�� Zip: S� Z i�.�l <br /> Sprinkler Contractor:�U r�.��•�.��'k- `S�:���-.�•1Telephone Number: ��� �£�� �.�.3� <br /> ��� <br /> Contact Person : !Y1,� �Gi yv�4�r�� License#: �S�� \ a3 <br /> Mailing Address: S�3 �'A RML CS E'\«� �\\� \�\��.��. f�'�� r, S�c.�� <br /> WATER SUPPLY <br /> Lake❑ Well� City ❑ <br /> BACKFLOW DEVICE <br /> AVB ❑ PVB ❑ <br /> Make W��k��� Model 7�G fl Year of Manufacture C,s�r.,1 Quantity � <br /> �rinkters: <br /> �Lc�.Y.10 i rc� �t�GG �-'�� �o�r� <br /> HYDRALILIC CALCULATIONS Design Data: <br /> Area of Application: 15�o Sq. Ft. <br /> Coverage per Sprinkler: T ss ,�'��� Sq. Ft. <br /> No. of Sprinklers: �� <br /> Total Water Required: �4�,� ��,.�.� ���.�,�- GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee: $ 50.00 <br /> 2. State Surcharge $ 5.00 <br /> 3. Mail-ln Fee $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add lines 1-3 above) $ �, .c'� <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 statement ade on this application are complete, true and correct. <br /> � <br /> Applicant ' ------ Date_ -�-/� <br /> Approved Approved with Corrections Denied <br /> Reviewed By: Date � ' �v ' �� <br /> Reset Form <br />