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HC 5329 �00) <br /> ENTRANCE HENNEPIN COUNTY �.�' CE+ � "�"'�°� <br /> PERMIT FEES Transportation Department �,j�5'� <br /> �A� Planning Division SEP 1 S 2008 '° Se "'y <br /> siNc� 1600 Prairie Drive <br /> RESIDENTIAI. sso.00 Medina,Minnesota 55340 ��,: <br /> TEMPORARY $100.00 " <br /> COMMERCIAIJ AP�'UCAT/ON FOR DR/VEWAY OR STREET ENTRANCE PE MIT <br /> srn�� $zoo.00 (READ:"General Requirements"on the Reverse Side) <br /> �E �T TELFPHONE PAGEFFI6EtL FAX <br /> �� <br /> �.'4- �l'r N�� (�1�-- ?Il.v- - � l�(�7 �'`!.6 <br /> � � � � STA � ���� <br /> �E��D�n'�� , 1 STREET ADDRESS CfTY STATE ZJP CODE <br /> � �i�l/T' /� <br /> � C� 7 <br /> O I I l._ <br /> CONT CTORPERFORMWGWORKQFKNOWM S'ff2�iADDRESS CfTY STATE �PCODE <br /> �. L J ' C�YL�`l:k.Y.-�1�D 1✓�1(�/ `753� <br /> 2.• APPLICATION IS HEREBY MADE FOR PERMISSION T0.CONSTRUCT AND THEREAFTER � DRIVEWAY(S) PUBLIC <br /> MAINTAIN ❑ STREETS <br /> 3. BUILQING TO BE CO�STP,UCTED: NO � YES � RESIDENCE ❑ SPECI�TYPE) <br /> 4. DRIVEWAY OR STREET WILL BE: � TEMPORARY � PERMANENT DATE PROPOSED <br /> ENTRANCE WILL BE NEEDED <br /> 5. IS THE PROPERTY: � PLATTED � UNPLATTED NUMBER OF PRESENT DRIVEWAYS � <br /> OR OTHER ENTRANCES TO PROPERN <br /> crn'Q���J�" `.' a�ear r+u►� <br /> 6. BUILDINGPERMITACQUIRED: NO � YES ,� <br /> i <br /> 7. TYPE OF PROPOSED ENTRANCE SURFACE: � BITUMINOUS � CONCRETE � ROCK � OTHER <br /> LOCATION-S7REEfADDRES COUNTY.ROAD CITY <br /> s. � S� �' (�� �- Sl f✓b , <br /> � noN-Ruww ❑ ❑ ❑ ❑ rmao oR srn�r <br /> 9' ON RURAL ROAD MILES ❑ ❑ ❑ ❑ OF <br /> DATE PRINTED NAME qp S�ryp � <br /> I� Sf ��`� ��.��- �c��s�ne � <br /> TO HELP THE INSPECTOR,PLACE STAKE WITH A CLOTH A7TACHED, IN THE ER OF THE PROPOSED <br /> ENTR.4NCE RND H/GHER THAN ANY SURROUND/NG VEGETAT/ON. <br /> APPLICANT'S DIAGRAM(IF SITE/CONSTRUCTION PLAN IS NOT SUBMITTED) <br /> :� <br /> pS�' <br /> ��� <br /> S� � <br /> . �n f� , � �,� � <br /> �c���, ,�,��� S�� -� �`6 P,�-� <br /> ' �,�, ��` � �, a,�, (,� <br /> ,�.� , '��{� t t � �Jt� -' <br /> ,� �_ ��� � � � - �/ <br /> � . --- - �'�'� <br /> �. --- - <br /> � -��.- ---- ��J 1 <br /> �� . � � <br /> 7 � � c � (� r <br /> „�^A 1 1 - --- Complete this form and send all copies to: Hennepin County <br /> � �f�X , ��� lq � Transportation Department, Planning Division, 1600 Prairie Drive, <br /> ,�n�- � �� `�,� '� 1��� Medina, Minnesota 55340. Phone: (612) 596-0355, FAX: (763) <br /> GO�!' -� �,(� �� y O u\ 4T8�000.After approval,one copy will be retumed to applicant <br /> C� iyl� ��� ��, <br /> � ��i C �� <br /> � ���,� <br /> c � .,��.� <br />