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� <br />'"""�- , Hc sa� i`s� HENNEPIN COUNTY <br />� ' Trans ortation De artment � <br />�� ENTRANCE P P Permit No. # � <br />"'""` PERMIT FEES Planning Division <br />'� 1600 Prairie Drive <br />� PRIVATE $50. Medina, Minnesota 55340 <br /> TEMPOFiARY $100. <br /> COMMERCIAL $200. APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT <br /> STREET $200. (Read "General Requirements" reverse side) <br /> Name of applicant Phone <br /> Address " <br /> (city) (state) (zip code <br /> { <br /> Name of Property Owner Address <br />.. � <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 /> 3. Building to be constructed: Q,Yes � No �,,Residence � Commercial (Specify Type) <br /> i�` ,. - <br /> ~ 4. Driveway or street will be: � Temporary a,Permanent Date proposed entrance will be needed: <br /> 5. Is the property: ''� Platted � Unplatted Number of present driveways or entrances to property: <br /> ... <br /> !" 6. Building Permitacquired: � Yes fl No City Permit No. <br /> 7. Type of proposed entrance surface. � Bituminous � Concrete �1 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 /> ANY SURROUNDING VEGETATION. <br /> APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted) <br /> ��, . <br /> �� , <br /> . .,�. <br /> �. ., , y . � .� ; ,� � . ; <br /> :... <br /> - �- • . . <br /> . .; _.., __ _ _;. > . _ <br /> _ <br /> . � , <br /> . . :.� .... . .: .. , _ _� .� }.:, - • - - - --• <br /> �'" - i ' " ` fi' '�, '� � � , � <br /> � � � z ,.�. � ..� ,., , <br /> � � � q� <br /> L..... . ,.. � � �.�,v�'� .`„..� . . <br /> 1 ��� �. . , _ �': <br /> 4.J. ��^ _'�u �__ ' ' �' _ �.} a <br /> _.�l f ' <br /> ;, <br /> �� �!, ��;�� �- � � ,, .:...> . _. <br /> . � . . <br /> � � �� � � <br /> _ ..� ..._� ..�___4.��.. . � <br /> . �...�..:�- "^i�A .. i �.. �''+. �' t <br /> __ � `'. <br /> `. ,l r , : . . ____ . _ <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: (612) <br /> '`r 478-4000.After approval,one copy will be retumed to applicant. <br />� <br />