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�rt i• � - w . . . . � .. <br /> 4. � � � � . � . . <br /> �. , .Hc 5szs - HENNEPIN COUNTY PUBLIC WORKS Permit No. <br />�,, 320 Washington Avenue South <br /> Hopkins, Minnesota 55343 <br /> APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT <br /> (Read "General 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 Phone <br /> 2. Application is hereby made for permission to construct and thereafter maintain: Driveway(s) Public Street(s) <br /> 3. Building to be constructed: o Yes � No � Residence � Commercial (Specify Type) _ <br /> 4. Driveway or street will be: � Temporary � Permanent Date proposed entrance will be needed: <br /> 5. Is the property: � Platted '� Unplatted Number of present driveways or entrances to property: <br /> 6. Building Permit acquired: � Yes o No City Permit No. <br /> 7. Type of proposed entrance surface. � 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 /> To help the inspector, place a stake with a cloth attached in the center of the proposed entrance, higher than any surrounding <br /> vegetation. <br /> APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted) <br />�. <br />�- <br /> . ;; <br /> '�, <br /> (Complete this form and send all copies to:Hennepin Counry <br /> Highway Division, Traffic Office, 320 Washington Avenue <br /> South, Hopkins, Minnesota 55343. Phone: 935-3381. <br /> After approval, one copy will be returned to applicant.) <br /> "�u._ . .. _ ., _... , ... � .,. ,.. <br />