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"'" `"'��'� HENNEPIN COUNTY PU LIC WORKS Permit No. �S-a �
<br /> `L..w�..�aaa�
<br /> 320 Washington Aven e South �}
<br /> Hopkins, Minnesota 5343 �_
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<br /> , APPLICATION FOR DRIVEWAY OR S REET ENTRANCE PERMIT ��
<br /> (Read "General Requiremen s" reverse side) z
<br /> _ �7��J , � ., I� c ,� �� �� x-
<br /> Name of applicant ��'� � Phone ��t% �"S ' "� ` _-�`
<br /> 1 �
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<br /> Address
<br /> (cit ) (state) (zip code)
<br /> , ���� . : . _
<br /> Name of Property Owner Address
<br /> . ; ��',2 L i _ /��--D f ' Phone �� 3 '��/ ��
<br /> 1. Contractor performing work ,
<br /> 2. Application is hereby made for permission to construct and thereafter aintain: VDriveway(s) Public Street(s) ,
<br /> � �
<br /> 3. Building to be constructed: � Yes � No �'Residence � Commerc al (Specify Type)
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<br /> 4. Driveway or street will be: o Temporary �Permanertt -•Date propos d entrance will be needed: """ ' �
<br /> 5. Is the property:
<br /> �atted � Unplatted Number of present drive ays or entrances to property: ��
<br /> /"1 .
<br /> 6. Building Permit acquired: � Yes �b No City � �"� � Permit No.
<br /> 7. Type of proposed entrance surface. � Bituminous � Concrete� R ck � Other
<br /> 8. Location
<br /> (Address) (Co. Road) (City)
<br /> , � - , , . � , . -,
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<br /> 9. Location, if ru al: �N ,S.,E.,or W,) (Road or Street) ��
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<br /> � ��� � . —�. �.c _ `_;'
<br /> �/r ! : A licant's Si nature ,
<br /> Dated , PP . 9
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<br /> To help the inspector, p�ace a stake with a cloth attached in the cen er of the proposed entrance, higher than any surrounding
<br /> vegetation.
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<br /> APPUCANT'S DIAGRAM - (if plot or construction plan is not submitt d) - m ""'. -
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<br /> - � ..`` �;` ' (Complete this form and send all copiesto:Hennepin County
<br /> � J � � 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.)
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