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� , <br /> �� <br /> j � /J�O • _ City of Orono FOR CITY USE ONLY <br /> ���0 P.O.Box 66 <br /> � 2750 Kelley Parkway Date Received: Permit# <br /> i� Crystal Bay,MN 55323 <br /> � Phone:(952)249-4600 Fax: (952)249-461 C Approved By: Amount$: <br /> � � <br /> y � <br /> F � <br /> `�kESHv��V CITY OF ORONO-LAWN SPRINKLER PERMIT <br /> PERMIT CODES(IN-HOUSE) <br /> Sprinkled Residential/Lawn Sprinkler/Blank <br /> Sprinkler/Residential/f3�ckFlow Device Only/Blank <br /> Please Check One: New Addition❑ <br /> Job Site Address: ��� ���1'I ��Q�� �1� �o ��Q(/�� �;.���� <br /> Owner: .� I�►'� �����CJ m.S Telephone Number: �J" .�Z ' .S�j y"f�f�yL <br /> Mailing Address: .�y.� Z°rnLl�' R� /G'+ rU�� ' �,.�,37� <br /> City: �C'U�� Zip: ,���..3�� <br /> Sprinkler Contractor: QV]��/�,�(yr ��Q/e �(�(, Telephone Number: 9�JZ v r,�6���� <br /> Contact Person: L�r(�!� License #: <br /> Mailing Address: ,d� ,�; .�J �a�'► ' (��i/7� U�i' .� _3.J Gi -�.3 J <br /> WATER SUPPLY <br /> Lake ❑ Well ❑ City� <br /> BACKFLOW DEVICE <br /> AVB� PVB ❑ <br /> Make � ��'�i vl� Model LU`�� Year of Manufacture ��l�� Quantity � <br /> Sprinklers: /"/Cl� a n' J_�! C l <br /> � <br /> J �1 <br /> HYDRAUL[C CALCULATIONS Desig ata: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee: $ 50.00 <br /> 2. State Surcharge $ 5.00 <br /> 3. Mail-In Fee $� <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 <br /> do all wark in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all stat ents ade on t is application are complete, true and correct. <br /> � <br /> Applicant ` Date � �O �,� <br /> Approved Approved with Corrections Denied <br /> Reviewed By: Date <br />