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� �� �G-- <br /> , Hcss2g s,9s HENNEPIN COUNTY PUBLIC WORKS Permit No. �' ' <br /> ENTRANCE 320 Washington Avenue South <br /> PERMIT FEES Hopkins, Minnesota 55343 <br /> PRIVATE $50. <br /> TEMPORARY �50. APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT <br /> COMMERCIAL $100. <br /> STREET �ioo. (Read "General Requirements" reverse side) <br /> , <br />��, pP .. _i- _?� � tyt#�>t � e_.:a,� '� Phone ��i.� '��,�'� :.; <br /> Nameofa licant _;."•i�:;ycy �,'ti�- i � :_•. ,� <br />� " j��3 q� w <br /> Address �� � �: ���(.'�1(,��i �1'"i � �...�'Y` �� ` � S^'J . ��, ; <br /> � (city) ��ate) �� (zip co e) ; <br /> f <br /> Name of Property Owner `::� CC,311��1�',, Address ,:.."�UY'�t��i� ' <br /> 1. Contractor performingwork (IfKnown) ���'� ��'C i�s T,�`i�,1/� �� BC�i�'ikV�,_�`. Phone '�`, '" '���� <br /> 2. Application is hereby made for permission to construct and thereafter maintain: r Driveway�s) Public Street�s) <br /> 3. Building to be constructed: � Yes �No �Residence � Commercial (Specify Type) <br /> �p <br /> 4. Driveway or street will be: � Temporary � Permanent Date proposeci entrance wili be needed: � "` s " ��_ <br /> (Permit expires one year from date) <br /> 5. Is the property: � Platted � Unplatted Number of present driveways or entrances to property: � <br /> i <br /> 6. Building Permit acquired: � Yes � No City ��'d"C1Y'1C Permit No. � <br /> 7. Type of proposed entrance surface. � Bituminous � Concrete � Rock � Other ` <br /> i... � <br /> 8. Location� .:��i� �`a.:� �C t�. C� � �`� :��Y°,`���3 <br /> (Address) � ` (Co. Road) (City) � <br /> 9. Location, if rural: � Miles �� of ��dl9s��:����� �"1 <br /> (N.,S.,E.,or W.) (Road or Street) <br /> Dated ��'��:[]ti,3 �+ `s'1#"�! �;^ Applicant's Signature -•tc� s.�'t.�-ytk ` ' '.. <br /> ` r C <br /> Printed Name �' ° �3%.�r;�`y� ��� , � <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 submitted) <br /> ....- = �,UT u�� .. <br /> , . . : . ..� _ '�r'�V�.�'�y �h� <br /> P,. .� . � ._...�. . ,-�:. <br /> � ` � � I / <br /> � �'� �ro o�� <br /> c��r� -. �' <br /> . + <br /> . <br /> �r� �t3�th a�' ` <br /> . <br /> �+ � ��, _ �'�3�y��d� � w��n � - 4 � �' ��fr <br /> y � � <br /> � � �.x��� �.�\v�.� � <br /> �' <br />� � o . ,� �,L�. ����.��;�c���z �� <br /> �E Ur CO��rqC'�"oY q�Vis�°C� � � <br /> wi�deh�'nq duP.. �'� �'��t�'��c� <br /> ' (Complete this form and send all copies to: Hennepin ' <br /> �;�""(;���,���� County Public Works Permit Office,320 Washington Avenue h <br /> South,Hopkins,Minnesota 55343. Phone:930-2548. <br /> After approval,one copy will be returned to applicant.) <br />