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<br /> � H v29 s�ss HENNEPIN COUNTY PUBLIC WORKS Permit No. ��9�� .:�;;
<br /> ENTRANCE 320 Washington Avenue South ,`�
<br /> PERMIT FEES Hopkins, Minnesota 55343 �'
<br /> PRIVATE $50.
<br /> TEMPORARY $50. APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT ''
<br /> COMMERCIAL $100. '
<br /> STREET $100. (Read "General Requirements" reverse side) � '�
<br /> Name of appl icant � �'`l i r�' r;� ��� � � �� �>'�`J'� �f�� ��
<br /> Phone
<br /> Address '` rr' �l./��[.!'�f fa �����'`E �,��,. ' �
<br /> (city) (state) (zip code)
<br /> ' ----• + :
<br /> Name of Property Owner , ���,•����r�`pE.% ��r; f%" Address _ ' .�-'
<br /> 1. Contractor performing work (If Known) Phone
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<br /> �2. Application is hereby made for permission to construct and thereafter maintain: Drivewayls) Public Street�s)
<br /> 3. Building to be constructed: � Yes � No � Residence � Commercial (Specify Type)
<br /> 4. Driveway or street wil� be: � Temporary � Permanent Date proposed entrance will be needed:
<br /> (Permit expires one year from date)
<br /> 5. Is the property: �'Platted � Unplatted Number of present driveways or entrances to property:
<br /> 6. Building Permit acquired: �R�Yes � No City Permit No.
<br /> �
<br /> 7. Type of proposed entrance surface. �Bituminous � Concrete � Rock � Other
<br /> 8. Location , ," �-�. . �,,�r' .
<br /> (Address) (Co. Road) (City)
<br /> f i t
<br /> 9. Location, if rural: MiFes' of
<br /> (N.,S.,E.,or W.) (Road or Street)
<br /> �
<br /> Dated � " Applicant's Signature • ` :' .�"' n<'.-- '`- ..-,�
<br /> , _
<br /> � Printed Name +
<br /> TO HELP THE INSPECTOR,PLACE A STAKE WITH A CLOTH ATTACHED IN THE CENTER OF THE PROPOSED ENTRANCE,HIGHER THAN ,
<br /> ANY SURROUNDING VEGETATION.
<br /> APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted) ���
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<br /> (Complete this form and send all copies to: Hennepin
<br /> County Public Works Permit Office,320 Washington Avenue �,,:
<br /> South,Hopkins,Minnesota 55343. Phone:930-2548.
<br /> After approval,one copy will be returned to applicant.)
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