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posits <br />He 53U HENNEPIN COUNTY PUBLIC W(%gKS Permo.. No. <br />320 Washington Avenue South <br />Hopkins, Minnesota 55343 <br />APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT <br />(Reed "Gomel RoWirernents" reverse side) —~ <br />Name of applicant C c?kLA0,41 A. C, j /ilfi�f'h < ,� Phone `>' �_�' " `✓! %/ <br />Address ' , �r CrJ,aTc.f"7c�/rsi- AW, e�lJN�i L�A itIA/ <br />(city)etata rip code <br />Name of Property Owner A 1IV XT,?sr X . - 7-6 06115; Address r1L c A*01& X'' h'®-A <br />�' i; T lj, �_ f %�' _ 1. Contractor performing work ,(`^� d1' t Phone <br />2. Application is hereby made for permission to construct and thereafter maintain: Driveway($) Public Streatls) <br />3. Building to be constructed: (JO.Yes ^ No ;) Residence Commercial (Specify Type) <br />4. Driveway or street will be: a Temporary ' KPermanent Date proposed entrance will be needed: n r <br />5. Is the property: Q Platted :'- Unplatted Number of present driveways or entrances to property: =�` ' r"l, j <br />8. Building Permit acquired: Yes q No City - <br />7. Type of proposed entrance surface. : ; Bituminous ; I Concrete Rock ❑ Other <br />Permit No. <br />8. Location —' i%. He <br />(Address) (Co. Road) (City) <br />8. Location, if rural: 7 Miles /` of / ` ` __ .' <br />(N., S., E., or W.) (Road or Street) <br />Dated x L Applif::nt's Signature <br />To help the inspector, plate a sta: with a cloth attached in the center of the proposed entrance, higher than any surrounding <br />vegetation. <br />APPLICANTS DIAGRAM - (If plot or construction plan is not submitted) <br />(Complete this form and send ail copies to Hennepin County <br />Highway Division MaintenanCe Office, 32C Washington <br />Avenue South, Hopkins, Minnesota 55343. Phone 93b 3381 <br />Afler .rtK)rovat, One t opy W111 he returned to epphcant I <br />