Laserfiche WebLink
-7 <br /> •. HC 5329(6/98) . e �.'� 7 <br /> HENNEPIN COUNTY <br /> ENTRANCE Transportation Department Permit No. <br /> PERMIT FEES Planning Division1 71, <br /> 1600 Prairie Drive <br /> PRIVATE $50. Medina, Minnesota 55340 <br /> TEMPORARY $100. ,"# , <br /> COMMERCIAL $200. APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT <br /> STREET $200. <br /> (Read General Requirements" reverse side) <br /> Name of applicant Phone ' <br /> q�ia.. —prt>ry'�^,h1..+� "+IEGC•...^S �u"�A'.�`I�''�E.IF!�Y�♦ °T.'�i' ,'K"' .M _b�F�",-4,,.�4 <br /> Address h, <br /> (city) (state) (zip code) °. <br />¢ Name of Property Owner Address t`1 <br /> 1. Contractor performing work (If Known) Phone <br /> 2. Application is hereby made for permission to construct and thereafter maintain: Driveways) Public Street(s) t +M,> <br /> + 3. Building to be constructed: L1 Yes ❑ No El Residence ❑ Commercial (Specify Type) AL <br /> _ <br /> 4. Driveway or street will be: ❑ Temporary ❑ Permanent Date proposed entrance will be needed. t <br /> �w <br /> 5. Is the property: ❑ Platted ❑ Unplatted Number of present driveways or entrances to property: <br /> 6. Building Permit acquired: ❑ Yes ❑ No City Permit No. <br /> 7. Type of proposed entrance surface. ❑ Bituminous ❑ Concrete o Rock ❑ Other t <br /> ' tP`r *:,i,: <br /> 8. Location <br /> (Address) (Co. Road) (City) <br /> 9. Location,if rural: Miles of " <br /> 1 (N.,S.,E.,or W.) (Road or street) <br /> z Dated Applicant's Signature <br /> Printed Name <br /> TO HELP THE INSPECTOR, PLACE A STAKE WITH A CLOTH ATTACHED IN THE CENTER OF THE PROPOSED ENTRANCE,HIGHER THAN <br /> a ti ANY SURROUNDING VEGETATION. b <br /> + APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted) q> v <br /> 6 VK <br /> y <br /> H # ' <br /> 4 <br /> A f <br /> 7 <br /> i+ti'�e 4 G rt y,;ysi .y 4i r.. ,k. `b a d �'e .. � � '��•"W+y�fi.� ,��, r r/Rd.�,e <br /> d fQ.-.. ��p 4 , y. tk Wt1'.� ..yY t Ng y}' E S, ✓ �^y�' " <br /> �F sF� �� ,... �'� ,..,.,r .�:., 3 :.���. 4`.,..„�' •�,.-... ,. ..$•.x�, .:"!>..!�., <br /> rrMt'. <br /> Complete this form and send all copies to: Hennepin County <br /> o Transportation Department, Planning Division, 1600 Prairie Drive, <br /> Medina, Minnesota 55340. Phone: (612) 745-7643, FAX: (612) <br /> 1•., 478-4000.After approval, one <br /> ` pp copy will be returned to applicant. <br />