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. 'O,¢p�O City of Orono ° ;g��������p�� <br /> P.O.Box 66 �: <br /> 2750 Kelle Parkwa � � �� ��� � � �� <br /> � Y Y 1�a�e�cC�usd �'eTm�Y# <br /> ��� Crystal Bay,MN 55323 � ���_ y <br /> Phone:(952)249-4600 Fa�c: (952)249�616 �j�pp�y�d$y � tl�ntsurit�: <br /> ��7 <br /> CITY OF ORONO—LAWN SPRINKLER PERMIT <br /> Job Site Address: �,� � 1ti �w( �' <br /> Owner: C-C.rW' Ll7 f.��.P Telephone Number: 1,�l� ���' 93�3 <br /> Mailing Address: <br /> City: Zip: <br /> Sprinkler Contractor��l h L�1��*S� Telephone Number: ��� q �� ��f�7 <br /> Contact Person : �'J •��D''L��-, License#: S�'�y !�- `Vj <br /> Mailing Address: Z� � r' �D �F' � � cS" �77 <br /> WATER SUPPLY <br /> ake ❑ Well ❑ City� <br /> LOW DEVICE <br /> vB ❑ PVB � (/'a.�ccc�M bre�� <br /> Mak�_,(� Model � Year of Manufacture Quantity / <br /> Sprinklers: <br /> HYDRAUI.IC CALCLTLATIONS 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: $ 35.00 <br /> 2. State Surcharge $ .50 <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 statem on this application are complete, true arid correct. <br /> : <br /> Applicant Date � ��' •��J� <br /> . ..................................... <br /> Approved Approved with Corrections Denied, <br /> Reviewed By: Date <br />