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�,:...,. iY ,. � _�'M'u.� ..�. _ . "i:�C5az9 -. HENNEPIN COUNTY PUB IC WORKS Permit No. � 320 Washington Avenue South Hopkins, Minnesbta 5 343 APPLICATION FOR DRIVEWAY OR ST EET ENTRANCE PERMIT (Read "General Requirements ' reverse side) Name of applicant Phone I Address (city) (state) (zip code) Name of Property Owner Address 1. Contractor performing work Phone 2. Application is hereby made for permission to construct and thereafter ma ntain: `Driveway(s) Public Street(s) 3. Building to be constructed: � Yes � No � Residence � Comm�rcial (Specify Type) 4. Driveway or street will be: � Temporary ❑ Permanent Date prop�osed entrance will be needed: 5. Is the property: � Platted � Unplatted Number of present drivewa s or entrances to property: 6. Building Permit acquired: � Yes o No City Permit No. 7. Type of proposed entrance surface. � Bituminous � Concrete o Roc � Other 8. Location (Address) (Co. Road) (City) 9. Location, if rural: AAi#es of (N.,S., E.,or W.) (Road or Street) Dated Applicant's Signature To help the inspector, place a stake with a cloth attached in the center of the proposed entrance, higher than any surrounding vegetation. � APPUCANT'S DIAGRAM - (If plot or construction plan is not submitted) ' •,' 4 , � -' " 's � _ � _ .._�. _ ��. ,�� _ _ �._ -- -- ��-. ...�, . a __k ,....,;.,_ �.. , � __ , , . ,_„ , , _. .- -, ;r;;,,. _ �''�r � . Gv�'�' � '`� `� .... �, , �� . � � , � � � ,-� ;j.;�.' � .. .r _ a '� � t% I, omplete this form and send all copiesto:Hennepin County ighway Division, Traffic Office, 320 Washington Avenue outh, Hopkins, Minnesota 55343. Phone: 935-3381. fter approval, one copy will be returned to applicant.) a , .-,_ _ �I