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H7(3M), HENNEPIN COUNTY PUBLIC WORKS Permit No. ^f <br /> 320 Washington Avenue South <br /> Y <br /> Hopkins,Minnesota 55343 <br /> APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT <br /> (Read "General Requirements" reverse side) <br /> ' Name of applicant �` � � �� ^� #�`��� •.f Phone <br /> Address <br /> (city) (state) (zip code) <br />•a <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(sr' Public Street(s) <br /> 3. Building to be constructed: ❑ Yes ❑ No a Residence 11 Commercial (Specify Type) <br /> a <br /> 4: Drivewa or st" _. <br /> y reef wits..fr `em f5or t� ` � oposenf$te vt'ri ne ``' .' <br /> (Permit expires one year from date) <br /> 5. Is the property: o Platted El Unplatted Number of present driveways or entrances to property: <br /> 6. Building Permit acquired: o Yes El No City Permit No. <br /> 7. Type of proposed entrance surface. 13 Bituminous 0 Concrete C3 Rock 13 Other <br /> 8. Location <br /> (Address) (Co. Road) (city) <br /> 9. Location,if rural: Miles of <br /> (N.,S.,E.,or W.) (Road or Street) <br /> Dated_` - } Applicant's Signature <br /> Printed Name �. <br /> "y <br /> TO HELP THE INSPECTOR, PLACE A STAKE WITH A CLOTH ATTACHED IN THE CENTER OF THE PROPOSED ENTRANCE,HIGHER TH N i <br /> • ANY SURROUNDING VEGETATION. <br /> a ' <br /> APPLICANT'S DIAGRAM -(If plot or construction plan is not submitted) <br /> i. .$�".'9 '^ !.•�rw.}sf"' L y.".`_'h�' h°_y' .� C':''l:+,f' A re -L-l�-sya�r,�� ~ �' mi '"� ', " v.w Y.. r+r^j _ , <br /> (Complete this form and send all copies to: Henne in <br /> County Public Works Permit Office,320 Washington Ave ue <br /> South,Hopkins,Minnesota 55343. Phone:930-2548. <br /> After approval,one copy will be returned to applicant.) <br /> s ._ <br />