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��; � <br /> ��.Ib�S �, C\ . U Cc�1a � �1,1 V S <br /> O City of Orono FOR CITY USE ONLY n <br /> �- �O P.O.Box 66 ? O� ���7 z/ <br /> 2750 Kelley Parkway Date Received: /u ermit�! � �r <br /> Crystal Bay,MN 55323 <br /> ,�hone:(952)249-4600 Fax: (952)249-4616 Approved By: Amount$: <br /> � � <br /> yF � <br /> ��K£s H o�� <br /> �" CITY OF ORONO- LAWN SPRINKLER PERMIT <br /> PERMIT CODES([N-HOUSE) <br /> Spnnklerr'Residential/Lawn Sprinkler/Blank <br /> Sprinkler/Residential/Backflow Device Only/Blank <br /> Please Check One: New ❑ Addition ❑ <br /> Job Site Address: -��`�5 �T�2t>r�� 1--�� <br /> Owner: �'�t�t� �V�,��,� Telephone Number: �l� �`�` ��'1�g <br /> Mailing Address: ����. <br /> City: U.�(y�-1�2�.c� Zip: '� S3�i1 <br /> Sprinkler Contractor: Telephone Number: <br /> Contact Person : �lM License #: <br /> Mailing Address: <br /> WATER SUPPLY <br /> Lake ❑ Well � City ❑ <br /> BACKFLOW DEVICE <br /> AVB ❑ PVB� <br /> �� / Make y �'�''� Model� Year of Manufacture aO� Quantity�_ <br /> Sprinklers: <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: � L' ��' G � Sq. Ft. <br /> Coverage per Sprinkler: -�j �� Sq. Ft. <br /> No. of Sprinklers: � v <br /> Total Water Required: / z--� GPM <br /> PERMIT FEE CALCULATION <br /> l. Permit Fee: $ 50.00 <br /> 2. State Surcharge $ �.00 <br /> 3. Mail-In Fee ! $ 2.00 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 abo�e) <br /> $ � _ U \� �� <br /> The undersigned hereby app ies to the City of issuance of a Sprinkler System Permit, agrees to do <br /> all work in strict accardance 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 Date �— � <br /> .............................................. ............................................................................................................................................................................. <br /> Approved Approved with Corrections Denied <br /> S � '� Date —��"�� � <br /> Reviewed By: '�Cf'7 ���S <br /> 1�C, �.; � �- C �� �'�---tt� i> ��1 , /`���' � (� . <br />