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L � <br /> Please check one: New � Addition <br /> , J <br /> .TOB SITF. ( ;� 1 �, C' C rc_t-C I� C- CLc/�— <br /> �� <br /> Owner's Name i"1•^ � /�?r s _ <S�� ����^ Telephone Number <br /> Mailing Address I_( � � ca c�,-� �(e ,� L.c���--t- <br /> Sprinkler Contractor's Name ��-�.;r�• �.S � ��t�-- �''�, TelephoneNumber ��� E.���-.?�.�2 <br /> Contact Person �.;� ! c��� � G, P � <br /> Mailing Address ��'� C� 1`� c�;�[ _�r /1�,c_� -�,• .-� ���n S_5 Z/�.3 <br /> WATER SUPPLY <br /> Lake Well �_ City <br /> BACKFLOW DEVICE , <br /> AVB PVB `�, <br /> T Year of <br /> Make Model Manufacture uantit <br /> Sprinklers ,�-��t�„ ��' ��' �� C=:�-- � .�-- <br /> r <br /> �-1:�.��..1.`,.- 1�i� L=J- t�l <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: a1 j�c`�� Sq. Ft. <br /> Coverage per Sprinkler: � 5 Sq. Ft. <br /> No. of Sprinklers: �- <br /> Total Water Required: ;� GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> The undersigned hereby applies to the City for 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 that <br /> all statements made on this app}ication axe complete, true and correct. <br /> /�,�� ` ��f <br /> �,` _ � � / ��� ,_ <br /> Applicant — �- � , � Date / � _ <br /> ********************************************************************************* <br /> Approved Approved with Corrections Denied <br /> Reviewed by: (�,� �_.� Date �"2� " �� <br /> � �- <br />