2011-00761 - lawn sprinkler - Laserfiche WebLink

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^ ¢��` City of Orono FOR CITY USE ONLY `r P.O.Box 66 � ��,,�, � 2750 Kelley Parkway �Date Received�� f� Perznit# �C�� C� ��D� � ��Y��y. � Crystal Bay,MN 55323 �'iii�'��+y�yE` Phone:(952)249-4600 Fax: (952)249-4616 Approved By: Amoant$:� � ��6Ao I CITY OF ORONO—LAWN SPRINKLER PERMIT PERMIT CODES(IN-HOUSE) Spririlcled Residential/Lawn Sprinkler i Blank Sprinkler/ResidentialBackflow Device Only/Blank Please Check One: Ne«� ❑ Addition ❑ <; �/� , Job Site Address: � � � S (O� � � r U c � �- Owner: Telephone Number: (�,1�_2��' �Gn CrC�— � Mailing Address: � C'ti ��y� d � City: C7 � C� /" C? Zip: .J � � Sprinkler Contractor:. I � Telephone Number: � ��- ' �f�r J �� Contact Person :� ��J �C Kl.l L�R License#: Mailing Address: WATER SUPPLY / Lake ❑ Well ❑ City�� BACKFLOW DEVICE AVB ❑ PVB [� r Make �. �� Model �C�� Year of Manufacture �L� Quantity � Sprinklers: - J � � ��. � ► � �--� HYDRAULIC CALCULATIONS Design Data: Area of Application: �� Sq. Ft. Coverage per Sprinkler: o Sq. Ft. No. of Sprinklers: °� � Total Water Required: � � GPM PERMIT FEE CALCULATION 1. Permit Fee: $ 35.00 2. State Surcharge $ 5.00 3. Mail-In Fee _�� 4. �OTj 1�E�I�EE(Add lines 1-3 above) /� Q� .,� V�, ��J' The undersigned hereb applies to th Cit ssuance of a Sprinkler System Permit, agrees to do all work in strict acc ance with t. or n es of the City and State regulations, and certifies that all statement d o 's ic ti re complete, true and correct. G �� b�� pl� Applicant Date l -� !- ........... ................................................................................................................................. Approved �. Approved with Corrections Denied Reviewed By: ��i��(�f Date � -�— � �