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Aoz��3 <br /> �35.�'v <br /> � Please check one: New�_ Addition <br /> � <br /> aos srrE �2. (� 9'S" �L:L L.y ��l L-` G= �C C'�� S' t �r� <br /> Owner's Name�y ��.Jq f� � � L, Telephone Number p <br /> �__t r� � <br /> Mailing AddresS . <br /> Sprinkler Contractor's Name �- �' � L'. �- TelephoneNumber � <br /> Contact Person L. � � L= <br /> Mailing Address 3 ��lJ�� �--G� � I-� �11 c� �� r.v �-. C o .y/�t} S S 3 � � <br /> `VATER SUPPLY <br /> Lake� Well City <br /> BACKFLOW DEVICE <br /> � AVB PVB <br /> � Year of <br /> Make Model Manufacture uanti <br /> Sprinklers � c� �f L R 2 m a a � (o <br /> TOTAL�s�pO.� <br /> HYDRAULIC CALCULAI'IONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: � G <br /> Total Water Required: 2 �_�',�/� /�61 GPM <br /> PERNIIT FEE CALCULATION <br /> 1. Permit Fee $ 3 5.00 <br /> 2. State Surchaz�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 Pernut, 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 application are complete, true and correct. <br /> - Applicant G, v,�� � o /U!L-` � Date / t�J � <br /> *********************** **************�********************** *************** <br /> Approved proved with Corrections Denied <br /> Reviewed by: ` ���%r.`/ <br /> Date 3-o�q 00 <br />