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Hc,S,szs HENNEPIN COUNT.Y PUBLIC WORKS Permit No. 3G��C <br /> 320 Washington Avenue South <br /> � Hopkins, Minnesota 55343 <br /> APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT <br /> (Read "General Requirements" reverse side) <br /> Name of applicant �f f� °d- O bi n Q � o ��K� Phone y7�-�l�� µ <br /> I $�3-5y 5�- cc� <br /> Address �( � '} � * N <br /> (ci y) (state) (zip code � <br /> Name of Property Owner rr � v� �o bi n ��KnrarK�_ Address <br /> 1. Contractor performing work m e�f� C4n�1'4r'�'1 n Phone <br /> 2. Application is hereby made for permission to construct and thereafter maintain: riveway s) Public Streetls) <br /> 3. Building to be constructed: �Yes o No �Residence ❑ Commercial (Specify Type) <br /> 4. Driveway or street will be: o Temporary �Permanent Date proposed entrance will be needed: ASAP <br /> 5. Is the property: � Platted � Unplatted Number of present driveways or entrances to property: � <br /> 6. Building Permit acquired: o Yes ➢Q No City � ��nD Permit No. <br /> 7. Type of proposed entrance surface. � Bituminous o Concrete �Rock o Other <br /> 8. �ocation U-n Plat1 ec�L�` P � U� a 71 18 a 3 3�C)00�. <br /> (Addreu) (Co.Road) (Clty) <br /> 9. Location, if rural: Miles of <br /> (N.,S.,E.,or W,) (Road or Street) <br /> Dated �`/ � ��a- Applicant's Signature��E� • (J��`J��� <br /> To help the inspector, place a stake with a cloth attached in the center of the proposed entrance, higher than any surrounding <br /> vegetation. <br /> APPLICANT'S DIAGRAM- (If plot or construction plan is not submitted) <br /> � y-ha�- par+ o�- -I-►,e t,t� 1�0. a5 rocts o i- �e N W Uy of S►,��/y <br /> 1� n e. E o f W 3�O' �-h e�e � �F (1 0-� Coun-k� roac�l. !o <br /> (Complete this form and send all copiesto:Hennepin County <br /> Highway Division,Traffic O�ce, 320 Washington Avenue <br /> South, Hopkins, Minnesota 55343. Phone: 935-3381. <br /> After approval, o�e copy will be returned to applicant.) <br />