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0,���`O City of Orono �� FOR CITY USE ONLY <br /> `r P.O.Box 66 / <br /> �, 2750 Kelley Parkway b,/� D Date Received: 7JZ�o /O Permit# ��/D-6G6 <br /> � 'ai � Crystal Bay,MN 55323 ��I�I I <br /> � ����"K.yo� Phone:(952)249-4600 Fax: (952)249-4616 Approved By: � � Amount$: ��• � <br /> CITY OF ORONO-LAWN SPRINKLER PERMIT <br /> ��' � ' � , � �_ - ��� �� <br /> ��:� � � ^,, ��" � � �^"€'�uu,'�� �`°r �..oa�1��. u h.� ��� r.� �����r ,� �' <br /> r. ���� <br /> . � t-- <br /> z ;.. <br /> � <br /> �. � � � <br /> ... . . ,�s�.� , ,.�., r, ��"�� . <br /> . ., a,�z'. <br /> �J�CO ��� <br /> Job Site Address: ~' Y� <br /> Owner: •����f,��r�.���h� Telephone Number:�i�1_��,�[����' <br /> Mailing Address: "j',(� �f-� ,� ��,��k� <br /> City: Zip: <br /> Sprinkler Contractor_T� �� � � p Telephone Number:CJ�'�=�{y�L�-�� <br /> Contact Person : G, ��f��-` License #: <br /> Mailing Address: � � � C� �{ (� o j�L, � �.t E���_���,,�,�;� <br /> WATER SUPPLY <br /> Lake � Well ❑ City❑ <br /> BACKFLOW DEVICE <br /> AVB ❑ PVB ❑ <br /> Make� Model Year of Manufacture Quantity <br /> Sprinklers: <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: � S' �C� ,��}�S 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 Date �� <br /> ............................................................................................................................. <br /> Approved '� Approved with Corrections Denied <br /> , 1 . �-, � <br /> Reviewed By: �"�/,� , ��'(. j�c�'�� Date � - � / �/G� <br />