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N: 3. PROPERTY OWNER INFORMATION 4. CONTRACTOR INFORMATION NAME: NAME: ADDRESS: ADDRESS: CITY/STATE/ZIP: CITY/STATE/ZIP: EMAIL: EMAIL: PHONE: PHONE: APPLICATION IS HERBY MADE TO INSTALL THE FOLLOWING IRRIGATION FIXTURES AT THE ABOVE LOCATION: NUMBER OF IRRIGATION HEADS: NUMBER OF BACK FLOWS: PERMIT FEE: APPLICANT SIGNATURE: APPLICANT PRINTED SIGNATURE: APPROVAL SIGNATURE: APPROVAL DATE: Submittal of the above information with a fully completed application is required to approve/.

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