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<br /> : t�c�:s � ` " HENNEPIN COUNTY PUBLIC WORKS Permit No.
<br /> 320 Washington Avenue South ;�;
<br /> Hopkins, Minnesota 55343
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<br />�;. . � APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT s,
<br />� (Read "General Requirements" reverse side) ,;;
<br /> Name of applicant Phone
<br /> Address '+<
<br /> ' (city) (state) (zip code) ;�
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<br /> Name of Property Owner Address �s
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<br /> 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: �
<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 � Rock � Other •`i'
<br /> 8. Location
<br /> (Address) (Co. Road) (City)
<br />„.`� 9. Location, if rural: Miles of
<br /> (N.,S.,E.,or WJ (Road or Street)
<br /> Dated Appiicant'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 /> (aee enclos�d �Iaeter Plan} _ ' `
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<br /> (Complete this form and send all copies to: Hennepin County
<br /> Highway Division, Maiatet�ance Office, 320 Washington �_
<br /> Avenue South,Hopkins,Minnesota 55343.Phone:935-3381. '.'�,
<br /> After approval,one copy will be returned to applicantJ �
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