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<br /> ��c-s�zs• HENNEPIN COUNTY PUBLIC WORKS Permit No. y , ` �,;�
<br />� 320 Washington Avenue South
<br /> Hopkins, Minnesota 55343 �'
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<br />� APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT �
<br /> (Read "Generai Requirements" reverse side)
<br /> Name of applicant Phone
<br /> Address
<br /> (city) (state) (zip code)
<br /> Plame of Property Owner Address
<br /> 1. Contractor performing work Phone
<br /> 2. Application is hereby made for permission to construct and thereafter maintain: Driveway(s) Public Street�s) ` ,,�`•"
<br /> 3. Building to be constructed: � Yes � No � Residence � Commercial (Specify Type)
<br />�t 4. Driveway or s�reet will be: o Ternporary � Perrnanent Date proposed entrance will be needed:
<br /> 5. Is the property: � Platted � Unplatted Number of present driveways or entrances to property:
<br /> 6. Building Permit acquired: � Yes � No City Permit No.
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<br /> 7. Type of proposed entrance surface. o Bituminous � Concrete o Rock o Other �
<br /> 8. Location
<br /> (Address) (Co. Road) (City)
<br /> 9. Location, if rural: Miles of
<br /> (N.,S., E.,or W.) (Road or Street)
<br /> Dated Applicant's Signature
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<br /> To help the inspector, place a stake with a cloth attached in the center of the proposed entrance, higher than any surrounding
<br /> vegetation.
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<br /> APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted) �"
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<br /> (Complete this form and send all copiesto:Hennepin County
<br /> Highway Division, Traffic Office, 320 Washington Avenue
<br /> South, Hopkins, Minnesota 55343. Phone: 935-3381.
<br /> After approval, one copy will be returned to applicant.)
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