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� vWNi'e".uiP....r,: ;.....� . ..y <br /> ='9�3,9s ' HENNEPIN COUNTY PUBLIC WORKS Permit No. �Q <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 �ioo. (Read "General Requirements" reverse side) <br /> Name of applicant Phone <br /> Address <br /> (city) (statel (zip code) <br /> Name of Property Owner Address <br /> 1. Contractor performing work (If Known) Phone <br /> 2. Application is hereby made for permission to construct and thereafter maintain: Driveway(s) Public Street(s) <br /> 3. Building to be constructed: � Yes � No � Residence o Commercial (Specify Type) <br /> 4. Driveway or street will 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: � Yes o No City Permit No. <br /> 7. Type of proposed entrance surface. ❑ Bituminous � Concrete � Rock o Other <br /> 8. Location ' � <br /> (Address) (Co. Road) (City) <br /> 9. Location, if rural: Miles 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. <br /> APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted) <br /> : P <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.) <br /> � <br />