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• .vN�.'tr�-raq--.�.^� v' '�f ••r -►3,,,�._. r,,+► ....ne•_-:r« •.7,41"—••• �. . i11 n-=+r.--w'�`, - it--eq�, .�(. 7F ,,. <br /> "3 t OV U f <br /> HENNEPIN COUNTY PUBLIC WORKS Permit No. -$2 <br /> " `~f <br /> 320 Washington Avenue South <br /> r <br /> Hopkins, Minnesota 55343 <br /> APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT <br /> (Read "General Requirements" reverse side) <br /> Name of applicant Phone <br /> Address <br /> (city) (state) (zip code) <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) Public Street(s) <br /> 3. Building to be constructed: 0 Yes 0 No 0 Residence ❑ Commercial (Specify Type) 1 ` <br /> 4. Drivewayor street will be: 0 Temporary1 <br /> 0Permanent Date proposed entrance will be needed: � t <br /> 5. Is the property: 0 Platted 0 Unplatted Number of present driveways or entrances to property: <br /> 6. Building Permit acquired: ❑ Yes 0 No City Permit No. <br /> 7. Type of proposed entrance surface. 0 Bituminous 0 Concrete 0 Rock 0 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 /> To help the inspector, place a stake with a cloth attached in the center of the proposed entrance, higher than any surrounding <br /> vegetation. <br /> APPLICANT'S DIAGRAM -(If plot or construction plan is not submitted) <br /> (Complete this form and send all copies to: Hennepin County <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.) <br />