2000-Henn Co driveway permit - Laserfiche WebLink

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-- -M � - .. . .. ....,.�-.. . -_. . �. -...�.�. '� F-tc532s s�9s HENNEPIN COUNTY PUBLIC WORKS Permit No. � �' �� ENTRANCE 320 Washington Avenue South PERMIT FEES Hopkins, Minnesota 55343 PRIVATE $50. TEMPORARY $50. APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT COMMERCIAL $100. �: STREET $100. (Read "General Requirements" reverse side) �f � Name of applicant —_—t �_� � Phone _': _ -!�:'�� 6 Address '` rald i. :�.. �, [s (city) (state) (zip code) ='!� Name of Property Owner ` ' ;' � ` ' '` ' .;.� Address ' ` � � ° 1. Contractor performing work (If Known) Phone 2. Application is hereby made for permission to construct and thereafter maintain: : �Driveway(s)~ Public Street�s) 3. Building to be constructed: o Yes d,,No � Residence o Commercia► (Specify Type) � 4. Driveway or street will be: � Temporary Q Permanent Date proposed entrance will be needed: �� (Permit expires one year from date) 5. Is the property: W Platted � Unplatted Number of present driveways or entrances to property: 6. Building Permit acquired: m Yes � No City Permit No. 7. Type of proposed entrance surface. � Bituminous k�Concrete � Rock � Other H. LOCBLIOf1 (qddress) � (Co. Road) i , �` � (City) � � # � : 9. Location, if rural: Miles of (N.,S.,E.,or W.) (Road or Street) t Dated Applicant's Signature Printed Name ' s� �� TO HELP THE INSPECTOR,PLACE A STAKE WITH A CLOTH ATTACHED IN THE CENTER OF THE PROPOSED ENTRANCE, HIGHER THAN ':;•� ANY SURROUNDING VEGETATION. �'' ,�� APPLICANT'S DIAGRAM - (If piot or construction plan is not submitted) ,: _ `. , . w, r. :..,. i. .,: .i. <• ,� ,. . ._ - _.r. _1'. {. _ .� �y « _ ..s , ,: . ., .,:. - 9 : " .� � �. , � � � . , , . , , ��. . ._ . , • ;_. .: � ; , - . ., - +�� (Complete this form and send all copies to: Hennepin County Public Works Permit Office,320 Washington Avenue South,Hopkins,Minnesota 55343. Phone:930-2548. After approval,one copy will be returned to applicant.) :, �, _ _.. _ _ .E