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JUL-�6-20�5 11��0 FROM PUBLIC WORKS TO 97634274382 P.02t02 <br /> HC 5325(R/(7p) � <br /> liENNEPIN C�UNTY NERM�T NUMBER <br /> � ENTRANCE Transportation Department 7�`� <br /> PERMIT FEES Planning bivision <br /> PRIVATEI 1600 Prairie Drive <br /> RESI�ENTIAL $5�.00 Medina, Minnosot� 55$4Q <br /> TEMPDRAAY $100,00 <br /> coMM�ar,iAu APPUCATIQIV FOR DRIV�WAY DR STREET ENTRANCE PERMIT <br /> STREET �a.00,00 ({��qp; ����nera( Fiequirements" on the Reverse Side} <br /> NAMEO�,APP NT � ^� TFLEI'HONE PAGER��� FAX ^�� <br /> ����S�.i �l.� ����.�' -71�3-7�'3-S qS' �3.�lZ7- �382 <br /> MqIL Af]DFt�SS ,... <br /> CITY STATE ZIP�QpE <br /> �3'7So Cros s-b w h ,a.�'�. St.����c. Zv 3 �1r�►Do� /�l n� 5� 30� <br /> NAME OF PRqPFRTY ON/NER � �STAE�1'ADDRE35 �� CITY 6'1 A7E Z1P CODE � <br /> �D �- �ss `�iC� 2550 5�� A�-e /�x�. O�o h o M,v S . <br /> COtJ ACTOR PEHFORM1NOtWORK(IF fQJOWN) fi fHEET A�DI�ESS � 0� s �GTY STATE ZIP COOE <br /> �- ��`►'1�5�.1 uilneV's �µ Vf' �-Iev r eS Lo�t�z� Mti 5�357 <br /> �• I APPLICATION IS HEREBY MADE FOR PERMISSI�N TO CONSTR�ICT AND THEREAFTER MAWTAtN � DRIV�WAY(S) � PUBLIC <br /> �� STR[EfS <br /> 3- If BUILt]ING T�8E CONSTRUGTEp; ❑ NO � YES � RE9IDENCE � COMMEFtCIAL <br /> —• _ (�PFC!FY T!P�) <br /> 4. DRIVEWAY OR S7REET"WILL BE: ❑ T�MPOflARY DATE PROPOSED � <br /> N � I'EflMANEN7 ENTRANCE W1LL 8E NEEb�q � 0� <br /> 5. IS THE PROPERTY: �PLA'TTED ❑ IJNp�A7TED � NUMSER OF PRESENT DRIVEWAYS <br /> , � Y QR 07H�F!ENTRANCES TO PROPERTY <br /> �� PEfiMIT NUMC3[R <br /> 6. BUfLDING P�RMITACG1UfRED: ❑ N� � YES �n �J/�j��'S Q�Qnv <br /> 7. TYPE OF Pl�OPDSED ENTRANC�SURFACE: �I 61TUMENdUS ❑ CC)NCRE�E � ROCK � 0�'H�R ^ <br /> - ,.�.._ ..w..... ,-,,,,,.W. W-.. <br /> . � LOCATiON-STREET QpOAF$5 couNTv R�Ai� CITY <br /> 8- Z55d �i X-f'1-� �t.�e.. NO . � (Q OI?-�a <br /> Lp(;ATION-HURAL ��— ROAD OR STREL^T �'� <br /> �' ON RURAL ROAD �MILES � 0 ��-,,; � OF <br /> f]ATE f�RINTEQ NAME AppLiCANTS�SIGNATURE "`- <br /> 7���0 5 J l,t�I� �l.(�J�JCt Yl-p t,�-�,e` �t��� . <br /> TO HELP 7"HE lNSPECTOR, PLACE A STAKE WlTH A CL�TH ATTACHED, 1 ME'CEIV7'ER pF TH�Pf��POSED <br /> ENTRAIVC�AND KIGHER TMAN ANY SUAROUIVD/IVG VEG�TATION. <br /> APPL.ICANT'S,C7IAGRAM (IF PLOT OR CONSTRUCTIDN PLAN lS NQ7 SUBMITTED) <br /> �� . <br /> �� �� <br /> � � <br /> Complate this form an�i send all copies to: Flennepin Counry <br /> Transportation Department, Planning Division, 16do Pra;rie Drivg, <br /> Medina, Minnesota 55340. Phorte: (7'63) 7ri5-7649, FAX: (783) <br /> 478�4QCiD.After approval,ono copy will be returned tp app�icant. <br /> TOTA� P.�i2 <br />