Entrance permit from Henn. Co. - Laserfiche WebLink

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� wHC 5329`ce,sa> HENNEPIN COUNTY " r ENTRANCE Transportation Department PermitNo. -.�3 S 7 PERMIT FEES Planning Division � . , - 1600 Prairie Drive r'-�W f� �,-., � PRIVATE _$50:� Medina, Minnesota 55340 • �t .' _ TEMPORARY $100. COMMERCIAL �200. APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT STREET $200. (Read "General,Requirements" reverse side) �, � -� �� ,� � `�, , ,J �. Name of applicant - � � � J � ' ` � Phone ' Address � (city) (state zip code Name of Property Owner Address " "" ' "�' " " 1. Contractor performing work Qf Known) Phone . 2. Application is hereby made for permission to construct and thereafter maintain: Driveway(s) Public Street(s) 3. Building to be constructed: � Yes ❑ No � Residence ❑ Commercial (Specify Type) __ = -- _ - _ _ _- .. . . �. ; 4. Driveway or street will be: ❑ Temporary o Permanent Date proposed entrance will be needed: " ' 5. Is the ro ert o Platted � Un latted Number of resent drivewa s or entrances to ro ert " �, � '� P P Y� P P Y P P Y� ' 6. Building Permit acquired: � Yes ❑ No City � �� Permit No. 7. Type of proposed entrance surface. o Bituminous ❑ Concrete ❑ Rock o Other 8. Location ' (Address) (Co.Road) (Ciry) 9. Location, if rural: Miles of (N.,S.,E.,or w,) (Road or Street) Dated Applicant's Signature Printed Name TO HELP THE INSPECTOR,PLACE A STAKE WITH A CLOTH ATfACHED!N THE CENTER OF THE PROPOSED ENTRANCE,HIGHER THAN ANY SURROUNDING VEGETATION. ` . . . .. APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted) ., L . �� .. � �... . � ..i�a._... .� �. . . . . . _l . ' ) . ., � . . . . . I . . . dlr . _ . . ��s'��.X1�",'��._�...:... . -:�"�'-'J=i.. Complete this form and send all copies to: Hennepin County Transportation Department, Planning Division, 1600 Prairie Drive, Medina, Minnesota 55340. Phone: (612) 745-7643, FAX: (612) 478-4000.After approval,one copy will be returned to applicant.