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. � <br /> �`'Hc ssz9'c�y8> HENNEPIN COUNTY ' i�J <br /> ENTRANCE Transportation Department PermitNo. � �� S / <br /> PERMIT FEES Planning Division <br /> . - 1600 Prairie Drive �. = <br /> � PRIVATE __$54- ' 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 /> �;:1;j �` '�I -:> u <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 /> 2. Application is hereby made for permissio� to construct and thereafter maintain: Driveway(s) Public Street(s) <br /> 3. Building to be constructed: o Yes ❑ No o Residence � Commercial (Specify Type) <br /> , _. ._ _ _. . ------ ,, _ _ <br /> ._ � -- . _ _ , . ._. _ _ <br /> 4. Driveway or street will be: ❑ Temporary � Permanent Date proposed entrance will be needed: � ' <br /> 5. Is the ro ert o Platted ❑ Un latted Number of present drivewa s or entrances to ropert i� <br /> P P Y� P Y P Y� " <br /> 6. Buildin Permit ac uired: � Yes ❑ I�to Ci `� <br /> 9 q tY � 6� � Permit No. <br /> 7. Type of proposed entrance surface. 4 Bituminous ❑ Concrete o Rock o Other <br /> 8. Location <br /> (Address) (Co.Road) (Ciry) <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 W/TH A CLOTH ATTACHED lN THE CENTER OF THE PROPOSED ENTRAIVCE,H/GHER THAN <br /> ANY SURROUND/NG VEGETATION. • <br /> APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted) � <br /> j. ... a .,. `. _ <br /> ��3 <':_ .__._ <br /> _� , <br /> -- � - �, • - • . , , , <br /> �.. . i <br /> e�;�„� <br /> ,. {;.:�::. <br /> �'`�� <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: (6f2) <br /> 478-4000.After approval,one copy will be returned to applicant. <br />