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11/16/98 08:56 FAg 812 948 1580 BARNUM �004 <br /> , � , , . � <br /> Hc�«�:� HENNEPIN GOUNTY <br /> 7 <br /> ENTRANCE Trenspoltdtion Department Permit No. � <br /> PERMIT FEES Planning Divfsion <br /> �• 1600 Prairie Drive <br /> PRIVATE $50. Medina, Minnesota 66340 <br /> TEMPORARY �100. <br /> COMMERCIAL $200_ APPLICATION FOR DRIVEWAY OR STREET EN7RANCE PERMIT <br /> STREET $200. <br /> (Read "General Requirements"reverse side) <br /> Name of�ppliC2nt �Q E� �_1Q�n7� r1�1 Phone � ��' ���� <br /> �a c a ���x Rxg�/�/� <br /> Address��s6y �A__ Ea�� �'�/a ��� <br /> e(tY rtate) ��p cod <br /> Name of Property Owner �R e¢ +- � RN v v1 ._Address /0 ,'lr��R R�LEft �fL <br /> Ew�S,.�� �Rw�Asq /NIN ss=y7 <br /> 1. Contr�CtOr performing work (Ii Known) PhonQ <br /> i <br /> 2. Application is hereby made for permission to construct and thereafter maintain: Drivewayls) PUb�it StrQot(s) ' <br /> 3_ Building to be consvucted��Yes o Np �esidence ❑ Commercial (Specify Type) <br /> 4. Driveway or street will be: � Temporary �Permanent Date proposed entrance will be needed: 1� �v �Q y j <br /> 5. Is the property' �PlattEd � Unplatted Number of ptesent driveways or entrances co p�oper2y: ��P� �' <br /> 6. Building Permit acquired' o Yes �No City Permit No. 'I <br /> 7. Type of proposed entrance surince. � Bituminous � Conerete �Rock � Qther <br /> � 8. Location � i2o^�- � � �QOIJ� <br /> � ( ddnu) (Co_Rood) ity) <br /> 9. Location,if rural' Miles et 1 <br /> (N_,5.,E_,or v1�.� �nowd O�SVYYt) <br /> pated 1 �� y 1 q �_ AppliCant's Signature <br /> Printed Name V �"'� <br /> TO MELP THE/NSPECTOR,PLACE A S1'AKE W/TN A CLOTH ATTACHED fN 1'HE CENTEA OF THE PROPOSED ENTRANCE,HIGHER THAN <br /> ANYSURROUNDING VEGETA770N, � � <br /> APPLICANT'S DIAGRAM- (If plat or const�uction plan is notsubmittedi <br /> \ . <br /> � � �z�X�� <br /> � SzTv <br /> � � <br /> $ � ��a Qo E� <br /> � � �R �w.�y <br /> / <br /> � �y9 �� > <br /> t�. � t C � <br /> ��y �4 <br /> Complete th�s form and send all coples te� Hennepin County <br /> �y� !� TranspoRstion Departrnent, Plenninp Oivisfon, 1600 Preirie Drive, <br /> Medina, Minnesota 55340. Phone: (61Z) 745-7643, FAX: {612J <br /> 47B�t000.After approval,one copy will be retumed to applinnt <br /> � C/iy/T7 � <br />