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� � � __,. <br /> � ��0 ���� City�of OrOnO CIT SE ONLY <br /> / ¢ � `� P.o.sox 66 �7 <br /> 1 � ;; ��`�� 2750 Kelley Parkway Date Receiv :� ennit# ���41� � � <br /> a � � �� ��� Crysrdl Bay,MN 55323 �-, <br /> ��'� '}�� ��o�� Phooe:(952)249-4600 Fax: (952)?49-4616 Approved By: Amount$: ✓i <br /> ��gp4 i; <br /> \:�__"- <br /> CITY OF ORONO—LAWN SPRINKLER PERMIT <br /> nEaMrr co�Es�►N-HousE> �� '� ti l���` 1���^-�..� � <br /> Spnnkled Residential/Lawn Spnnkler/Blank � �'' <br /> Spnnkler/Residential/Backflow Device OnlyBlank � � � <br /> � :� �.� / � <br /> Please Cl�eck One: New ❑ Addition ❑ <br /> Job Site Address: ���j,�'D fv n �( <br /> Owner: /If� ,�j� G U � Telephone Number: �%d -��/ ` 6 6a� <br /> Mailing Address: v���';7 �!��.�'' /? �t,-J ��', <br /> City: 0 t�:,,—'� Zip: �J .�' " y <br /> Sprinkler Contractor: ���/_���r ;,��,:_�;,r' Telephone Number: ��„2 ` ,;��'„C. -� �f��'S�' <br /> Contact Person : f?r��r.� �a i�;�'� License#: � � ��� � � <br /> Mailing Address: ,¢E[�r_ .S,�r;'� (�C�er F� B�� �t`��� l'-C.l�� r�; VY9e*- /��:a� ,�.� 3,5b <br /> WATER SUPPLY <br /> Lake� Well ❑ City❑ <br /> BACKFLOW DEVICE <br /> AVB ❑ PVB ❑ <br /> Make Model Year of Manufacture Quantity <br /> �rinklers: <br /> HYDRAULIC CALCULATIONS Design Data: <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 $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add lines 1-3 above) <br /> $ <br /> The undersigned hereby applies to the City of issuance of a Sprinkler System Permit, agrees to do <br /> all work in strict accordance with the ordinances of the City and State regulations, and certifies <br /> that all statements made on this application are complete, true and correct. <br /> Applicant �� �v'''� !/ Date � " � �' ' f V�. <br /> Approved Approved with Corrections Denied <br /> ReviewedBy: ��������C.�, _ Date �� -1 �►d`— <br />