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� - � T. , ,�i . <br /> . 5� _�� <br /> `�/ "� �� APR 1 6 1999 <br /> Please check one: New 1` Addition <br /> JOB SITE_,�-v� C S �\ �,,; -}- � S 11c,,� � �� � �� � Gi�Y'v;=G��a�;��;� <br /> Owner's Name I � s�� r��u r '��l�-� Telephone Number � 7 3 - �G S�. <br /> ' ,t� sh- � f <br /> Mailing Address S � �;r � , - <br /> Sprinkler Contractor's Name /�*'c��'Yl� S er�i-c-� � Telephone Number C�������-- <br /> .� � � <br /> Contact Person ��+����v� c��,�� <br /> Mailing Address -5�--'`� / �c��� ��� �� C� i�� � . <br /> `VATER SUPPLY <br /> Lake�_ Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers � ,ti-�e�' �-�c-' /�9 l /C:�� <br /> ��� �� 6�;'� J ��%�{ �-��l�-- /9�y 6� ��-- <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: ��'Z-'z-' Sq. Ft. <br /> Coverage per Sprinkler: `�,5 Sq. Ft. <br /> No. of Sprinklers: j,�� <br /> Total Water Required: ;� S� GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 3 5.00 <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 a lication ar complete, true and correct. <br /> ; <br /> Applicant �� �� �' Date !� �y <br /> *********************** ******************************************************** <br /> Approved � Approved with Corrections Denied <br /> Reviewed by: � ���ry�, <br /> Date �"J <br />