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- - <br /> � � <br /> `'�c sazs'is,�e� 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 "Generai 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 (If Known) Phone <br /> � <br /> 2. Application is hereby made for permission to construct and thereafter maintain: Driveway(s) Public Street(s) <br /> �.: <br /> 3. Building to be constructed: o Yes � No � Residence o Commercial (Specify Type) <br /> 4. Driveway or street wili be: � Temporary � Permanent Date proposed entrance will be needed: <br /> � <br /> 5. Is the property: � Platted � Unplatted Number of present driveways or entrances to property: <br /> � <br /> ; 6. Building Permit acquired: 4 Yes o No City � � '� Permit No. <br /> 7. Type of proposed entrance surface. o Bituminous � Concrete � Rock � 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 /> i: ANY SURROUNDWG VEGETATION. <br /> APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted) �. <br /> . � -�..,,,�,,,,....«�...... <br /> , i. , __.-. } , , <br /> . _ , � . <br /> . , _. , ; .. � _ _, _ ... :.. _ _ - <br /> F <br /> � � - � � �} - �_ � t;_. . � ���a � � � <br /> � 5� <br /> y;. . . � .! - . . <br /> � . . � . .� ' . . � � . �� <br /> � . � . . � . . . . ���fy . <br /> '�)i <br /> . . � . . .. . . �� ti�.. M� . <br /> �� <br /> L � <br /> . ' . . . ' ., - . �' �3`L.... <br /> . . . - � . . � - k .�.� ;� <br /> B` y iy� y �� y <br /> , <br /> ,/ <br /> Complete this form and send all copies to: Hennepin County <br /> Transportation Department, Planning Division, 1600 Prairie Drive, F <br /> Medina, Minnesota 55340. Phone: (612) 745-7643, FAX: (612) <br /> 478-4000.After approval,one copy will be returned to applicant. <br />� k, <br />