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HC‘ii3w lyts! <br />ENTRANCE <br />PERMIT FEES <br />PRIVATE S50. <br />TEMPORARY S50. <br />COMMERCIAL S100. <br />STREET S1CX3. <br />HENNEPI^i COUNTY PUBLIC WORKS <br />320 Washington Avtmia South <br />Hopkins, Minnesota 55343 <br />Pirnnit No.59/7 <br />APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT <br />(RMd “Gen«ral R«quirtment$" r*v*rs« $id«) <br />i ^r____________ption* y/Oiz^CrZ.Namt of applicant ^ <br />Address ^ ^ <br />J j n ^ <br />icitvl IftAtai iz^p cooaf <br />Name of Property Owner il Address <br />V/1.Contractor performing work (IT Known) *___*Phone <br />2.Application is hereby made for permission to construct and thereafter maintain: '^Dnyewayltj ^ Public Streetts) <br />3.Building to be constructed: X ^Residen ce c Commercial (Specify Type) --------— — <br />4.Uriveway or street will be: O Temporary Permanent Date proposed entrance will be needed:yar from date) <br />5.Is the property: XPlatted a Unpianed Number of present drivevyays or entrances to property .--------------------—---------- <br />6.Building Permit acquired: O Yes H No City i <2 o Permit No. <br />7 Type of proposed entrance surface,Bituminous 2 Concrete 2 Rock 2 Other <br />r r.^A O J J8.Location I Aodraui <br />9.Location, if rural:Miles <br />tCo. Roaol <br />of <br />(C*ry) <br />Dated <br />IN.. S.. e . or W.) <br />Applicant's Signature ’ > <br />(Road or Straat) <br />V . v'\ <br />pr nted Narr-e <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 submined) <br />(Compl«t0 this form and send ail copies to: Hennspin <br />County Public Works Permit Office. 320 Washington Avenue <br />South, Hopkins, Minnesota 55343. Phone: 930-2548. <br />After approval, one copy will be returned to applicant.)