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<br /> . . y��z9�6'98> HENNEPIN COUNTY �� �r� �
<br /> r ' ENTRANCE Transportation Department Permit No. '
<br /> PERMIT FEES Planning Division �
<br /> 1600 Prairie Drive
<br /> PRIVATE $50. Medina, Minnesota 55340
<br /> TEMPORARY $100. � '�" ` , �� �� 3�' ♦
<br />�;: COMMERCIA� $200. APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT �; ' };rf� � � ;� >;Y�� ,.
<br /> 3�; STREET $200. ` �� ��'
<br />�,,, (Read "General Requirements" reverse side)
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<br /> 4.:M Name of applicant Phone
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<br /> "� Address `�
<br />�, (city) (state) (zip code) `
<br /> Name of Property Owner Address �
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<br /> 1. Contractor performing work (If Known) Phone :s�
<br /> ,� ��< < 2. Application is hereby made for permission to construct and thereafter maintain: Driveway(s) Public Street(s)
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<br /> j"Y 3. Building to be constructed: o Yes � No � Residence � Commercial (Specify Type) l"
<br />�� 4. Drivewa or street will be: � Tem o ��'
<br /> Y porary Permanent Date proposed entrance will be needed: ,{
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<br /> = 5. Is the property: ❑ Platted � Unplatted Number of present driveways or entrances to property: ''
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<br /> 6. Building Permit acquired: �fYes � No City Permit No. � � j ,s�
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<br /> 7. Type of proposed entrance surface. o Bituminous � Concrete 4 Rock � Other
<br /> 4} 8. Location �`�,�
<br /> (Address) (Co. Road) (City)
<br /> 9. Location, if rural: Mites of
<br /> (N.,S.,E.,or W,) (Road or Street)
<br /> Dated Applicant's Signature
<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.
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<br />� , APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted) i f , j ` }��
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<br /> Complete this form and send all copies to: Hennepin County ��
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<br /> ; Transportation Department, Planning Division, 1600 Prairie Drive, �
<br /> } t q Medina, Minnesota 55340. Phone: (612) 745-7643, FAX: (612) �
<br /> 478-4000.After approval,one copy will be returned to applicant. _�;
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