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r <br /> HC 5329(6/98) HENNEPIN COUNTY <br /> ENTRANCE Transportation Department Permit No. <br /> PERMIT FEES Planning Division <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 It; r 11 64iu Phone <br /> Address LO_ ?Si Cvtrtr � JV <br /> (city) r (state) (zip code) <br /> Name of Property Owner !'`PPE?:, >c �ea�;=y� 11��t,� i : ' Address il/],,1�dr r f1: 4,1, <br /> 1. Contractor performing work (If Known) 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: 11 Yes El No El Residence EJ Commercial (Specify Type) <br /> 4. Driveway or street will be: El Temporary 11 Permanent Date proposed entrance will be needed: <br /> 5. Is the property: El Platted 1-1 Unplatted Number of present driveways or entrances to property: <br /> 6. Building Permit acquired: EJ Yes 0 No City Permit No. <br /> 7. Type of proposed entrance surface. El Bituminous El Concrete 0 Rock El 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 /> TO HELP THE INSPECTOR, PLACE A STAKE WITH A CLOTH ATTACHED IN THE CENTER OF THE PROPOSED ENTRANCE, HIGHER THAN <br /> ANY SURROUNDING 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 /> Transportation Department, Planning Division, 1600 Prairie Drive, <br /> Medina, Minnesota 55340. Phone: (612) 745-7643, FAX: (612) <br /> 478-4000.After approval, one copy will be returned to applicant. <br />