|
.__T. _ _
<br /> . ,.;�.. �_,
<br /> Hcs3z9 s;9s HENNEPIN COUNTY PUBLIC WORKS Permit No.
<br /> �. , -��
<br /> �` 'EIVTRANCE
<br /> 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 />�i.,..:a. ' . .
<br />�'�:
<br /> Name of applicant Phone �
<br />�, -�
<br />'�� Address �
<br /> (city) (state) (zip code)
<br />� 7'
<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 o Residence � 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: Q P�atted � Unplatted Number of present driveways or entrances to property:
<br /> 6. Building Permit acquired: o Yes :G�' No City Permit No.
<br /> 7. Type of proposed entrance surface. � Bituminous � Concrete � Rock ,Q Other
<br /> 8. Location
<br /> (Address) (Co. Road) (City)
<br /> f � 9. Location, if rural: Miles of
<br />� + (N.,S.,E.,or WJ (Road or Street)
<br />'" Dated Applicant's Signature
<br /> Printed Name
<br />'�:;
<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 /> ,:�r
<br /> ,v,
<br /> APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted) � � x�
<br /> ti 4^
<br /> ., .K WS lW.�Astw yysiPlYew`m'. u.,. � . � ..b'P,M
<br /> , ¢ .. . . . 't'^�I
<br /> w +> �,.r.W.H .�.4,� _ wR.a�
<br /> � - . . � � . �, � �. �: t
<br /> .. � .. . . . � � � . . -�. , . . � � �_,., , � M�ti"�°"wYi#P' �wni:.� '""r�M
<br /> . . ... ' � �.J
<br /> y , � ^�ww,-+ti�a"'�,'��.,.: � � -. , - . , ,. w„rs i 4 ��, � .� a
<br />�'' - ���t � �'. „t -:�. ..�„;. . . ���'.: } j; � - a-,.. . . .�,•..` .: .��, ,a s � 4
<br /> ;� , .f �� r.. �' � ;:r � .. y 6 .. �}:.� S.�n;; ., ''t�
<br /> � � ��f �.f''°'.� �'" . .,�,- i '.f�"' L./��V�� �.�t{"� , �:i
<br /> ,� �
<br /> . �y�`+"�,l�N e/61A,.r r,; n.i� � .t � � 5r,. ,. ,.� �,�y�,�s= . ,�
<br />, . . �� j �^, �.
<br /> l�fs�:1 Y'f .L.A�I►P"'Y� Y'` .._��^'_"-�.---�.,���...,,...... �,�
<br /> . ; . ,1:. ;.,......,....,, :✓"� � . ...-.......`.,.......�.-+,....�.. �- �..� _ -` .� „o,"w,.,} ' . .. . d,
<br /> � . � i. � � . . . . �. � .
<br /> - . . . . � ��. ^�l: :. , ..� . � . .:'.� . � . � � . . .. . . . . ,�
<br /> f t
<br /> .. . . . . �� ��'{t�i�i�� . � . /� � � . ;�
<br /> , . � . � . ��� � � ` . � � . . . . . .. .�
<br /> i . � . . . . . . . .. . . .
<br />� � �• . . . � f� � . /^ � . .� - . ... . .. .
<br /> � , � . . . . . .� � �' . . . . - . � � �
<br /> -
<br />� f . . ,: �? . . . ... ... ���.
<br /> r �
<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 /> �� `�i.;
<br />
|