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a <br /> HC 5329 HENNEPIN COUNTY PUBLIC WORKS Permit No. <br /> 320 Washington Avenue South <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: ❑ Yes 0 No a Residence ❑ Commercial (Specify Type) <br /> 4. Driveway or street will be: 0 Temporary A Permanent Date proposed entrance will be needed: <br /> 5. Is the property: 0 Platted ❑ Unplatted Number of present driveways or entrances to property: f~' <br /> 6. Building Permit acquired: ❑ Yes 0 No City Permit No. <br /> 7. Type of proposed entrance surface. 0 Bituminous ❑ Concrete a,Rock ❑ Other <br /> r <br /> 8. Location <br /> (Address) .. (Co.Road) l (City) <br /> 9. Location, if rural: Miles of <br /> (N.,S.,E.,or W.) (Read or Street) <br /> Dated Applicant's Signature - • <br /> f <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 />