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<br /> Hc 5aze i� �� HENNEPIN C�UNTY PUBLIC WORKS Permit No.
<br /> 320 Washington Avenue South
<br /> Hopkins, Minnesota 55343 J�;�
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<br /> ��_,s� � `: 4. APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT ' fs�`.k;
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<br /> 3,, (Read General Requirements reverse side)
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<br /> Name of applicant Phone �q
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<br /> '� ` Address x�`:
<br /> (c�ty) (state) (zip code)
<br /> Name of Property Owner Address r:'`
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<br /> �n 1. Contractor performing work Phone " �
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<br /> 2. Application is hereby made for permission to construct and thereafter maintain: Driveway(s) Public Street�s) `'•�
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<br /> 3. Building to be constructed: � Yes � No � Residence � Commercial (Specify Type) :�
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<br /> 4. Driveway or street will be: � Temporary � Permanent Date proposed entrance will be needed:
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<br /> 5. Is the property: � Platted � Unplatted Number of present driveways or entrances to property: `'�
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<br /> 6. Building Permit acquired: � Yes � No City Permit No. ��
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<br /> � 7. Type of proposed entrance surface. � Bituminous � Concrete o Rock � Other {;�
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<br /> - 8. Location +�
<br /> �i; (Address) (Co. Road) (City) K�
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<br /> 9. Location, if rural: Miles of �:
<br /> (N.,S.,E.,or W.) (Road or Street) �'
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<br /> .' Dated Applicant's Signature "a�
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<br /> k`��' To help the inspector, place a stake with a cloth attached in the center of the proposed entrance, higher than any surrounding
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<br /> 4 , APPUCANT'S DIAGRAM - (If plot or construction plan is not submitted) "; ' ; x�� , � ' ' � °" '` '
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<br /> � �* ; + ` (Complete this form and send all copies to: Hennepin County
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<br /> -:� i� , , �k�:k ` Highway Division, Maintenance Office, 320 Washington 5�
<br /> o „i�'`,f � '` Avenue South,Hopkins,Minnesota 55343,Phone:935-3381. �;�
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<br /> After approval,one copy will be returned to applicant.) �
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