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v <br />ENTRANCE <br />PERMIT FEES <br />PRIVATE <br />$50. <br />TEMPORARY <br />$100. <br />COMMERCIAL <br />$200. <br />STREET <br />$200. <br />HENNEPIN COUNTY <br />Transportation Department Permit No. l'� <br />Planning Division <br />C <br />r Mi;NSjtjvE5340 <br />APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT <br />(Read "General Requirements" reverse side) <br />Bahiand €�avolop nt tnc <br />Name of applicant <br />Phone <br />Address <br />(city) (state) .zip code <br />�y;� �•T�:�.:91:1Nti� l�er���>a�r�� ,f�,r_ �;' i:1�� <br />Name of Property Owner Address <br />1. Contractor performing work (If Known) <br />2. Application is hereby made for permission to construct and thereafter maintain: Drivewaylb <br />3. Building to be constructed: Yes ❑ No o Residence ❑ Commercial (Specify Type) <br />4. Driveway or street will be: ❑ Temporary `b Permanent Date proposed entrance will be needed: <br />612-720-6505 <br />Phone <br />Public Street(s) <br />5. Is the property: Platted ❑ Unplatted Number of present driveways or entrances to property: <br />6. Building Permit acquired: ❑ Yes No City t5 �' Permit No. <br />7. Type of proposed entrance surface. A Bituminous ❑ Concrete ❑ Rock ❑ Other <br />Co R**d 146 Orono <br />B. Location <br />(Address) (Co. Road) (City) <br />9. Location, if rural: Miles of <br />(N., S., E., or w.) x_ (Road or Street) <br />Dated Applicant's Signature <br />Printed Name <br />TO HELP THE INSPECTOR, PLACEA 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 />P1*&&e see oncLased conatruotLon pie;! <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 />478-4000. After approval, one copy will be returned to applicant. <br />