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<br /> `� HC 5329 �'� � HENNEPIN COUNTY PUBLIC WORKS Permit No. _
<br /> 320 Washington Avenue South �
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<br /> t, Hopkins, Minnesota 55343 �,����
<br /> �1,,, APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT �
<br /> ' (Read "General Requirements" reverse side) j�
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<br /> Name of applicant Phone :�
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<br /> 4 Address `"
<br />�;" (cityl (state) (zip code) �
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<br /> � Name of Property Owner Address ` ,�
<br /> 1. Contractor performing work Phone '�
<br />�,: 2. Application is hereby made for permission to construct and thereafter maintain: Driveway(s) PubFic Streetls) ��
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<br />;:- 3. Building to be constructed: � Yes � No � Residence � Commercial (Specify Type) ;�
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<br /> 4. Driveway or street will be: � Temporary � Permanent Date proposed entrance will be needed: 1 �
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<br /> 5. Is the property: ❑ Platted � Unplatted Number of present driveways or entrances to property: "`
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<br /> 6. Building Permit acquired: � Yes o No City Permit No. t..�
<br /> s ��� 7. Type of proposed entrance surface. o Bituminous � Concrete � Rock � Other
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<br /> r• 8. Location
<br /> (Address) (Co. Road) (City)
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<br /> -= 9. Location, if rural: Miles of =
<br /> y: (N.,S.,E.,or W.) (Road or Street) ?•
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<br /> k-, Dated Applicant's Signature
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<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.
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<br />�'� APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted)
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<br />�' ' (Complete this form and send all copies to: Hennepin County f
<br />' Highway Division, Maintenance Office, 320 Washington �
<br /> Avenue South,Hopkins,Minnesota 55343.Phone: 935-3381. ��
<br /> After approval,one copy will be returned to applicant.) ;�'N�
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