2001-Henn Co entrance permit - Laserfiche WebLink

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�Hcs3z9;��o0� HENNEPIN COUNTY PERMITNUMBER ENTRANCE Transportation Department ""'°� ` '' � PERMIT FEES Planning Division pRivqTEi:- 1600 Prairie Drive RESIDENCIAL $50.0o Medina, Minnesota 55340 TEMPORARY $100.00 COMMERCIAL/ APPL/CATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT STREET $200.00 (READ: "General Requirements" on the Reverse Side) NAME OF APPLICANT TELEPHONE PAGER FAX � MAIL ADDRESS CITY STATE ZIP CODE `;�� �� NAME OF PROPERTY OWNER STREET ADDRESS CITY STATE ZIP CODE CONTRACTOR PERFORMING WORK(IF KNOWN) STREET ADDRESS CITY STATE ZIP CODE 1. 2. APPLICATION IS HEREBY MADE FOR PERMISSION TO CONSTRUCT AND THEREAFTER MAINTAIN � �DRIVEWAY(S) � PUBLIC STREETS n COMMERCIAL 3. BUILDWG TO BE CONSTRUCTEQ: . NO ,. , � YES � 4 RESIDENCE U (SP�CIFY TYPE} ;_ ' `-.,-, DATE PROPOSED 4. DRIVEWAY OR STREET WILL BE: ❑ TEMPORARY � PERMANENT ENTRANCE WILL BE NEEDED 5. IS THE PROPERTY: ❑ PLATTED ❑ UNPLATTED NUMBER OF PRESENT DRIVEWAYS OR OTHER ENTRANCES TO PROPERTY CITY PERMIT NUMBER 6. BUILDING PERMIT ACQUIRED: ❑ NO �+YES 7. TYPE OF PROPOSED ENTRANCE SURFACE: ❑ BITUMINOUS �ONCRETE � ROCK � OTHER LOCATION-STREET ADDRESS COUNTY ROAD CITY � :-.,t� � 8, '�'. LOCATION-RURAL ROAD OR STREET 9' ON RURAL ROAD MILES ❑N ❑S ❑E W❑ OF x DATE � PRINTED NAME APPLICANT'S SIGNATURE � 4. �. � :'-��._ .'.�� ' i� .. .,� . . . ,_..��...�-^--•.-..... . TO HELP THE INSPECTOR, PLACE A STAKE WITH A CLOTH ATTACHED, IN THE CENTER OF THE PROPOSED ENTRANCE AND HIGHER THAN ANY SURROUNDING VEGETATION. APPLICANT'S DIAGRAM (IF PLOT OR CONSTRUCTION PLAN IS NOT SUBMITTED) , • . � , � 1r/".t:'V � . dr� :!'�� r' ?i..;l t� .'!' ��;`� I �_.._. ..: � �:�+ � _ ` �...'��+ -- �Y , R�- ! "�` 'a` — _ F _ _ a J� � � �� .. .I � . r .�.fP� F��: .,.� 1"�:ii','��rC.`/'fl 'j� .i xf'."'f�'..l .a�fc`/"'�A✓�� ,%+''} . , f1`�f.�` ,.N'litf!/ . �11r.d'�, � ` �^�' � . _ ` �' . . . �,/ . . � � . .� C. ..i fi�y/�'f svZR ✓�.f I,ys ✓ . . � � . . . ' � . . . I' . . . . . . . , . . ' . . . . . . . .. . I'r _ . ` . . . .r�' �i( . ...�. . ..1� ` ��t�A1 ! � � . . . ' . � . ' . � . . � � �.. . � ... . . . . .. . �` ,r' � , x r'_.:i� � I , j, � � � - � �-»�. . � . . .�� d�. � .�.. '. .. . -:N.ur ..r. .,r...b.w �. �.}yY,+... , t�' 1 h. � y�y b I }Qq F l .f g rt � . . . . � . . . . . . . . x Complete this form and send all copies to: Hennepin County Transportation Department, Planning Division, 1600 Prairie Drive, Medina, Minnesota 55340. Phone: (763) 745-7643, FAX: (763) 478-4000.After approval,one copy will be returned to applicant.