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, 4 «, . 04��0 City of Orono FOR CI USE'ONLY <br /> P.O.Box 66 <br /> � �� o�i � 7/ <br /> �t �,� 2750 Kelley Parkway Date Received: Permit# � <br /> ���'��.��= � Crystal Bay,MN 55323 <br /> V��`��yo` Phone:(952)249-4600 Fax: (952)249-4616 Approved By: Amount$:�� <br /> 0 <br /> CITY OF ORONO-LAWN SPRINKLER PERMIT <br /> PERMIT CODES(IN-HOUSE) <br /> Spnnkler/Residen[ial/Lawn Sprinkler/Blank <br /> Sprinkler/ResidentiaUBackflow Device OnlyBlank <br /> Please Check One: � New� � Addition ❑ °�'���� ' ��,��� � � "�`� <br /> �� � ��:� <br /> �� <br /> Job Site Address: ,2.,.� ��'�'�L��e'�� <br /> Owner: ����� ��� � � � Telephone Number: � 7 Z' � I ��"�7� �Z- <br /> Mailing Address: �� /"1 �� � �w�e� <br /> City: ��'G� Zip: ���� ( � <br /> � .��� f� � <br /> Sprinkler Contractor: � �� - Telephone Number: �,�Z' "�-f� ' �`� <br /> Contact Person : � License #: � �� � l7� l <br /> Mailing Address: <br /> WATER SUPPLY <br /> Lake ❑ Wel� City❑ <br /> BACKFLOW DEVICE <br /> AVB ❑ PV$�, <br /> Make ` L���odel � Year of Manufacture� Quantity� <br /> Spnnklers: �- <br /> ��� �� ..��� � � � <br /> ���r 7� <br /> HYDRAULIC CALCULATIONS Design Data: --, <br /> Area of Application: 2� �(� Sq. Ft. <br /> Coverage per Sprinkler: �" r% �� Sq. Ft. <br /> No. of Sprinklers: U <br /> Total Water Required: ' .. � �' GPM <br /> I� �2U?��j ��E;����j C:�Z'�-� � � Z` �� <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee: �� ��� �� �'�� � $ 35.00 <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 /> °� 4' 1 - �r�-' , <br /> Applicant Date �� r � <br /> ........................................ .................................................... .... <br /> Approved " Approved with Corrections Denied <br /> Reviewed By: �] � �,.�'� Date � � ��(�;� -- I � <br />