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� , Hcssz9.�siss HENNEPIN COUNTY PUBLIC WORKS Permit No. �� �� <br /> ENTRANCE 320 Washington Avenue South <br /> PERMIT FEES Hopkins, Minnesota 55343 <br /> Y� PRIVATE $50. <br /> TEMPORARY $50. APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT <br /> COMMERCIAL $100. <br /> '� STREET �100. (Read "General Requirements" reverse side) <br /> Name of applicant � i�"���`��,�� �GC�� ��` j��("�"t��'1�`t Phone a73 "��`i�.�" <br /> Address �� �Q C�E"1rV��i KCY1f�] � �U'E I ,. ��'�i� ��� J��J" " ��,_ <br /> (city) °—�( 'ate) �„ (zip co e) <br /> ;�` Name of Property Owner_ � ���' Address :�t��'�l�i <br /> 1. Contractor performing work (!f Known) ��"Q �(;�"�',���V� 0�'` ��i� Phone ��"�'���� <br /> _ .�� <br /> 2. Application is hereby made for permission to construct and thereafter maintain: rivewa s) Public Street(s) <br /> �- <br /> 3. Building to be constructed: � Yes �No �Residence � Commercial (Specify Type) <br /> � � � - . . � _ . _ . _ � �'� ,�,, - <br /> � _.�. ._ , . . �, . <br /> . ?;...s . . �'::�*h�... .� ........ ..:.. . F ��,;'..,- .., . �...:.. ... . . ...... . . ......: �.... . ..J �. . . . .. �. . <br /> 4. Driveway or street will be: � Temporary �Permanent Date proposed entrance will be needed: i� _� ���_ <br /> (Permit expires one year from date) <br /> ' 5. is the property: � Platted � Unplatted Number of present driveways or entrances to property: � <br /> Yz <br /> 6. Building Permitacquired: � Yes � No City ��t"Q�Q Permit No. <br /> • 7. Type of proposed entrance surface. � Bituminous � Concrete f� Rock � Other <br /> �• <br /> � <br /> 8. Location„� �� � �Vf'aid . ��-��' �� ��t"`��� <br /> (Address (CJ o. Road) (City) � <br /> 9. Location, if rural: � Miles �• of �t��'�I.��t��A���'�" <br /> i (N.,S., E.,or W.) (Road or Street) <br /> Dated�Ci�l � ���� i <br /> ..:�r� `��' <br /> q Applicant's Signature ���� �� �3�.3���'�� <br /> Printed Name Y : � .��F��V �:`C'Y"kl�"�`;'a!`� <br /> a <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 /> _ ...- : ������ <br /> . . . .. , ., . <br /> ,�, _ -.�:,. _ ; � ..,-: _ ._• _ . _ ;: _ ,,,,.... , _ . �� <br /> '�` �t r �.�� �t�'� <br /> r � <br /> .. <br /> w � " � <br /> �uJv�r� ��`Q�t1�,� <br /> ,f :' � <br /> � - � � � �{�L � � � �L�+V►� ��� <br /> � � <br /> �,-�` � ��`" � � � t�� � - 4� o��' �, <br /> � �+� � <br /> ,� � � <br /> � � � � ������ ��� <br /> , ,� oyr c,t��+��rqC�'�"'t�� 4�vi�s+�C� '���t� ��i�r�r��p�`� <br /> W i�8�i t n� t�e�t� �� `i't��"�'i t"�C� <br /> �������c (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 /> � <br /> t <br /> �. _ <br />