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,¢��` City of Orono A ��,V� FOR C Y USE ONLY <br /> � r� P.O.Box 66 � fV <br /> �,,. < ' 2750 Kelley Parkway I'I�/b � ��j t,�. <br /> � '��y�� '�`� � Crystal Bay,MN 55323 ��! Date Received�� �� Permit#���Q" �/ / � <br /> ���y,�y�r�`V�y� Phone:(952)249-4600 Fax: (952)249-4616 � � <br /> �xo� Approved By: Amount$: <br /> 1 `� <br /> CITY OF ORONO—LAWN SPRINKLER PERMIT �J <br /> Please Check Oi��� � ��,�, �� � ,�, `�,4�� � } :�, '°� �� �� =�.� ,�� �� <br /> � � ��. �.. �- ��: �� <br /> Job Site Address: �f������������ �� ��, m��� <br /> Owner: ��"� �_�C ��_ Telephone Number: ��2 � 7��__�_T�ct <br /> ��-- <br /> Mailing Address: �S'�a�,-�E <br /> City: Zip: <br /> Sprinkler Contractor: �(`/Vl�.j- C � Telephone Number: Q�� c.�y���7� <br /> Contact Person : G c��C License#: <br /> Mailing Address: �_ � C� v � �(¢� � ,��,,� f�' c�_� i tiN c 7 R� S ��� <br /> WATER SUPPLY <br /> Lake � Well ❑ City❑ <br /> BACKFLOW DEVICE <br /> AVB ❑ PVB ❑ <br /> Make Model Year of Manufacture Quantity <br /> Sprinklers: <br /> �C S r� �� R ./� s <br /> HYDRAULIC CALCULATIONS 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 $ 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 � U� � �(� Z Date ( � 4� G <br /> ........................................ ............................ ..................................................................................................................................................... <br /> Approved 4J r' Approved with Corrections Denied <br /> Reviewed By: l,t/� Date � �`' `/ d <br />