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nr w,n-,F' <br /> 5 u LL V)bm 11 2 1 ,A.51 6 <br /> t 9^(3/95)VHENNEPIN COUNTY PUBLIC WORKS i <br /> � <br /> ENTR0. <br /> I I �� 1 V.011, VV 320 Washington Avenue South L� <br /> PERMI S VV Hopkins, Minnesota 55343 <br /> PRIVATE $50. <br /> `TEMPORARY $50. APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT <br /> • COMMERCIAL $100. <br /> STREET $100. (Read "General Requirements" reverse side) <br /> .j <br /> Name of applicant _l.� Phone <br /> Address r " ?' L� <br /> (city) (state) ' (zip code) <br /> Name of Property Owner Address <br /> 1. Contractor performing work (If Known) `` ` r Phone `/ r %' <br /> 2. Application is hereby made for permission to constuict and thereafter maintain: Drive;4(s) Public Street(s) <br /> 3. Building to be constructed: 0 Yes . No El Residence 0 Commercial (Specify Type) <br /> r—,-r41-Jariveway:or street.:will.bes_;� r purer _,r Permanent -Date proposed entrance willFbe needed: Pe mit expires one 1�1 e <br /> ( p year from date) <br /> 5. Is the property: /Platted o Unplatted Number of present driveways or entrances to property: <br /> 6. Building Permit acquired: 111..Yes ❑ No City Permit No. <br /> 7. Type of proposed entrance surface. ❑ Bituminous g Concrete 0 Rock 0 Other <br /> 8. Location ' I �(t <br /> (Address) (Co. Road) (City) <br /> 9. Location, if rural: Miles of <br /> (N.,S.,E.,or W.) (Road or Street) <br /> Dated 14 l / Applicant's Signature - 'i <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 /> a rt <br /> (Complete this form and send all copies to: Hennepin <br /> County Public Works Permit Office,320 Washington Avenue <br /> South,Hopkins,Minnesota 55343. Phone:930-2548. <br /> After approval,one copy will be returned to applicant.) <br />