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\ <br />HENNEPIN COUNTY <br />DEPARTMENT OF TRANSPORTATiON <br />320 Washington Avenue South • <br />Hopkins, Minnesota 55343 <br />APPLICATION FOR INSTALLATION OF UTILITIES <br />Countv Road No..Permit No. 19077 <br />Municipalitv_2r°I!£ <br />LOCA1 lON AND/OR DESCRIPTION OF WORK Application it hereby madt lot pwrmssMsn to placa. construct artd thareaftar <br />maintain a Vault _______ , ----- .., — - ■ a <br />.iPPnp,».v»»r^..o.yH..^w,yNn 15 all n:ITox 1 tp.atg IV 0 ^ edst QT Center] 1/16 Of . <br />Russell Vvonue m anoroxiratelv 13.T east of centgriine PusseH Avenue._____________ _ <br />NAME of applicant ^ ^---------- ■rrm-------PhoneVears Park Centre, C. 5'‘h it., it. -aul, 'A 5s ‘01 _ _ _ _ <br />-------------------------------------------------------------------------------------------tt«i« ne <br />.............................to ■*.^cc <br />Clt» <br />>'aii> ir organisation performing work Contractor unoer Sid <br />Address ___________________________________________ <br />Phone (Businettl. <br />tt«i* <br />Phone (Emergencvl_ <br />I. TYPE OF CONSTRUCTION - Submu live copies el detailed piirii inowme ivpe end location ol ii*uaiiei*on. <br />ns Under^ound □ Aenei O Other <br />3. TYPE OF UNOIRGHOUND CONDUIT <br />S4M <br />□ Multiduct <br />□ Pieit« <br />G Concrete <br />□ Steel <br />Oepih <br />tfon <br />□ Cooper <br />□ Ceore□ ___ <br />:o“Omih 8' <br />3. METMQOQP INSTAtUNG UWOEW WOAQtEOS <br />i D ■oring - Jeching - Pneumegopner <br />3 the eastbourd rlcnt-^and lane ulll nee^_ <br />to be rer.ovea tc construct vaul : <br />4 AREA TO BE DISTUHBEO <br />TRAVELED SURFACE aHOULOER <br />>c s Concrete <br />6<lumiitoul s Bituminous <br />Gravel <br />BOULEVARD <br />Sod <br />Fieic Creus <br />STRUCTURES <br />□ Curb A Guitar <br />□ StStTMih <br />□ S.grtaii <br />5. All wore under rr*u permit will be completed on or beiore <br />□ Culverts <br />□ RoedSiens <br />□ Other ___ <br />□ Trees <br />C ShruH <br />‘lovefT.ber 1, 1991 <br />Date <br />• PERMIT IS VOID AFTER THIS DATE! <br />If work cannot be compieied within detti tpecilied, e wrisien laowatl lor permrssion ol ealeniion must be made lo the Mennepin County <br />Oeperiment ot T'eniporteiion. \ <br />Eecept lor the negiieani acts ol the County, its ^nts and iis amptoyees. the Utility or Permittee shell euome ell liebiliiv lor end save the County. <br />Its aoems end .ts employees. Harmless Irom eny end ell claims lor demeges. Kiions or cauiM ol action arising out ol the work to be dorw l^em ^ <br />the coniiru^ uses by the Permittee, .nctudlng but not limned lo the piecing, eonsirucnng, recenttrucnng. rTtamiaming a«d using or swd utility <br />under tha%plication and Permit lor construction. • • • i . - <br />II Wei the undcrsi^ted. iterewith accept me terme end cor*diiior»t ol trte regulations as laid done* by me County or Menneoirt end agree to H»il» <br />eomoWlh«ew.dS to the selillecbonol me Menneorn County Oeperiment olT.eruooftaiion. . ____, ^ <br />Hetroo9U>iR-wt>^te Control Cofiwission <br />Orggauebon. <br />P4\ X, <br />V <br />r-3///?(^