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, -, - , ' -� � <br /> %"����`�,� City of Orono � R CI �USE ONLY <br /> %�4 •r \ P.O.Box 66 � [� / � l ^� �t�,, <br /> ''�,, �\? 2750 Kel ley Pazkwa_ . ?I I L, (� / Date Recei�� f7�Imit# `„7'�.���' v7 � � <br /> ���, �i•t. ►'`I Crystal Bay,AR�I 55323 �f� y —. <br /> `�!'��•-i�,�`F Phone_(952)249-4600 Fax: (952)249-d616 Approved By: Amount$:�s!�� <br /> ��.. ifp09,..; <br /> CITY OF ORONO- LAWN SPRINKLER PERMIT <br /> ��t��rr conEs�irr-i��ot�s�� <br /> Sprinkler�Res�denhal/L.awn Spn�ilcler�F31a�il; <br /> SprinkledResidentialfBackflow Device�hd}�iBlarilc <br /> Please Check One: New Addition <br /> Job Site Address: Z Z SO �'t Pr1C�� �.�'u[ ILpG(� <br /> O«-ner: �U i� ��� e��0� �q Telephone Number: ��� �f,��, Z3 � � <br /> Mailing Address: �,.�`�a ��Q1! G. � �Na�r f�-O�►� <br /> Ciri�: �a��'�i+ Zip: � �i � �4 i <br /> Sprinkler Contractor:�1�- �X�i'�-���.�✓� `� Telephone Number: �/ 2-- `Z� �' �)1' � <br /> Contact Person : � c((�i�t Li ense#: N�(`�- <br /> Mailing Address: <br /> '��g, �`J �'-�_�a����'Z_.� <br /> WATER SUPPLY <br /> Lake ❑ Well� City ❑ <br /> BACKFLOW DEVICE <br /> AVB ❑ PV� <br /> Make �"� � ��--�•' . Model -° �.��-" Year of Manufacture ��'� Z Quantiri� / <br /> Sprinklers: �' <br /> r9Q�.`J l��y�.�� <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: / SU�'��'� Sq. Ft. <br /> Co��erage per Sprinkler: '"`:� ' Sq. Ft. <br /> No. of Sprinklers: ;; � <br /> Tota1 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 /> -t. TOTAL PERMIT FEE(Add lines 1-3 above) $ _ <br /> The undersigned hereb�� applies to the Citv of issuance of a Sprinkler S��stem Permit, agrees to <br /> do all �;ork in strict accordance with the ordinances of the Ciri� and State regulations, and <br /> certifies that all statements made on this application are complete, true and correct. <br /> �r� � � <br /> Applicant `-� �'''�' Date �� �Z- <br /> Approved �A proved���ith Corrections Denied <br /> Re��ie�t-ed B��: � Date C� � � �"r " l� <br /> Reset Form <br />