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�,¢��� City of Orono FOR CITY USE ONLY <br />, �� �A:,� P.O.Box 66 ��� �( <br /> ���, . �� 2750 Kelley Parkway Date Received:���� ii�ermit# �11�a—� �" � <br /> ��a� tiyt�' �•'.. �;� Crystal Bay,MN 55323 <br /> i�¢. <br /> ��t �:���o�� Phone:(952)249-4600 Fax: (952)249-4616 Approved By: Amount$: <br /> �04 i <br /> CITY OF ORONO—LAWN SPRINKLER PERMIT <br /> PERMIT CODES(IN-HOUSE) <br /> Sprinkler/Residential/Lawn Sprinkler/Blank <br /> Sprinkler/ResidentiaVBackflow Device Only/Blank <br /> Please Check One: New❑ Addition ❑ <br /> � �3 _`"� ��� C � ra �� ;���r R� <br /> Job Site Address: ' <br /> Owner: ���'' '��, �'��� `-'� Telephone Number: �/ di v 1�.�'J ^i� g� <br /> Mailing Address: .S� M� <br /> City: �r�N b Zip: <br /> Sprinkler Contractor: /Q&�� Sp�'��`��` Telephone Number: gJ � `� ���' �� �'�� �� <br /> Tcc . <br /> Contact Person : �7�"��—'� License#: ,l��. v d, 6�3 `� co,.�7�NA G�y� �poo�� <br /> ��� <br /> MailingAddress: ��,(,�2, ,Sp1-�'�1�,�� �' ,�05� �6� ; FL�` �;�U�,� /`11V�. �S'�3CI <br /> WATER SUPPLY <br /> Lake ❑ Well� City❑ <br /> BACKFLOW DEVICE <br /> AVB ❑ PVB � <br /> Make Model Year of Manufacture Quantity <br /> Sprinklers: � � <br /> ;,v�A7��H ry���'c� J �3 � o�� I 2� <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: / d <br /> Total Water Required: -a'"`-F' 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 � Date .S — � � "/ � <br /> .............................................................................................................................................................................................................................. <br /> Approved Approved with Corrections Denied <br /> Reviewed By: Date <br />