Laserfiche WebLink
, <br /> hc eax c� � P�rmit <br /> PERMIT FEES HENNEPIN COUNTY Na 3d Y�S�, <br /> Transpartation D�partrnsnt ,�,+� � <br /> MUKiciv�urr = ssaoo Q�mtions Division.Permit Ofiioe `Z�`� Ros�d Na. �� <br /> �u�oTMERs = i�aoa 1600 Prairi�Drive-�Aed��e,Minnesote 55340-5421 <br /> Phone:(763)745-T600 FAX: (763)478-4002 u o <br /> PERMlT APPLICATI4N FOR tJTI�IT'Y CONSTRUGTlON ��'�`'°' -� <br /> LOCATlpN ANDlOR DESCRIPTION OF WORK:Appl�atlon is hereby made for permissbn to plac�consVuct and the�afl�mainteln a <br /> �"rz�.s+ �O�c.�...�. Gt-udr /1Un Ta dU.�c r�i t,�. ��T'�}t1.1�-..�s�r'.�.a� . <br /> a�ong or scrass Gounty R�sd . �/ (trorn,at) �f� GUv.t'r S��t- Gr�'G'r-r.t ��.�T �Yz'��� �v�- <br /> �p �iiT ti ci�t�_ -----.�., _ _._ <br /> Appinent_. ��1,��� -- <br /> Addross �!� .l.�� _. ../� _ !v �% <br /> Phone �� 7'��7'�.�� _._ 24 F�.Emerpency Phone �Jr�y7fi �7�� <br /> FAX No. �9�1'N y�t o'7:3 y �q�-'{33fl ��4X� <br /> SUBMIT A CHECK PAYABLE TO'HENNEPIN COUNTY TREASURER". <br /> SUBMIT TWO(2)COP1E3 OF ENOtNEERIN�DRAWlNOS FOLDEG TO 8112"x 1.4"..(DRAWING WILL NOT SE RErURNEd). <br /> 1.TYPE OF CONSTRUCTYON <br /> 00 Undw�raund G Aerial rl Other <br /> 2.TY_P�.. OF l��?ERQROUND CONDUIT � <br /> Size Deptl+ 5me DeOth <br /> 7 MultiduCt .. ._..... _ rl It�on _._..... _. <br /> � Plastic .... . ...._ _._. � 'iJ Copper �.... <br /> � Wncrvt� p Cable <br /> . C7 3tsel .- --•--- - — ❑ -_ . _..._ <br /> 3._METHOO.�F INSTALLING U.Np�I� ROADBEDS �°"'@� <br /> 'u� Borinp•Jackk�•Pneumayophicr(48"rnirimum depth) C5� 7�� p�°► � �''�� r <br /> � Cealnfl-Cartiar Pipe nquired for ail inatallations oxeaod'mg�inchas in diemeter.l�F N�+L�L1�'^� � <br /> ;J Open Cut-Cap PERMIT OFFICE prior to making apptic�tion. <br /> ......:.:__.. .,...__.. __ . <br /> 4. ►�REA TO BE DISTURBED ` <br /> TRAVELED 3URFACE �J�pf,� BOULEVARD <br /> C! Coriuete f-1 Curb d,GutUor O Bituminous �J Culverta � Sod � TroeslS�jrubs <br /> L1 Bituminoua C] Sidewalk ❑ Gravel O Field Grasa J OtherlZ4A�0 �11�� <br /> 5-A11 work done under this pecmR,inC�udtng restoretion,wiU be Completed o�or before 3��Z' <br /> It work cannot b.oornpl�Osd vrithin dates spedlied,a written request for pennLsslon of extension muat be made to Hennepn CauMy <br /> Trenapo�tion OeperUnent Ii s reQuest for exteneion ia not made prior to ths expiration of the PCm�it as noted fn Lfne 6 above,the <br /> Permit sbll bpOpmO nuM�nd v0id on the explretlon dete. � <br /> Th� Portnit�o agra�s 10 dafand, Indamnity, pnd hold hsrmless the Ceunty, its oficlels, of'lloers, employees, and agents A�orn any <br /> liability, dairns,a�uses of action,judflemente. or eupensvs, includirp n�sonsbls stEorneys'fess, rosultlrp diroectly or indirecxly irom <br /> % eny act or omi�sion ot the Permittee,Ita subcontrooiero,anyone direatly or indireaUy empbyed by th�m,And/4r 8nyone for whose acts <br /> andlor omissio��V»y may bo�iablo,arising out ot ths work to b0 cWne under this Penrr�lt, and a�ainst all loss by r�son of tha ta�lure <br /> � of the Pem�ittee b�perfom�fully,in any respect,atl obligatlons undsr tfiis PermK.Pem'�ICee herewkh aoce�s the tertns at�d condibons <br /> pf tAe req�allons es lald daNn by the County and aprees to fuNy comply therswith to ths se�tisfilClipn of the liennepin Cou�ty <br /> Transportation DopsrlmaM. ,., <br /> Organiza8on <br /> — By(Prn,�n�an,e) �.�i.�.•lI/�GKr� Dac� �.�/—OL <br /> PRIOR TD STARTING <br /> CQNSTRUCTJpN, CALL si�nature _.. <br /> 63 T45-7600 �P r�av 8E RFJECTED JF NOT SJONIcD BY REPRESENI'ATNE AtlTNOR17�ED <br /> T T�D ALL 7��atfS M►n Cavarravs co�vrArne�kF�&x. <br /> A�,wJ� �(�- G'� "�s <br /> S�0'� dS6�T0 Z0/ii/?i 200b-8Lt-8�L R1uno� uidauua�..� <br />