Laserfiche WebLink
HC 5329 9/00 <br /> ENTRANCE HENNEPIN COUNTY R.�' CE+ �`j� "�""B��j�„ <br /> PERMIT FEES Transportation Department <br /> �A� Planning Division SEP 1 S 2008 6B ""' <br /> SINGLE 1600 Prairie Drive <br /> RESIDENTIAL $so.00 Medina,Minnesota 55340 ��,: <br /> TEMPORARY $100.00 "'-- <br /> coMn��cv,u APPLICAT/ON FOR DR/VEWAY OR STREET ENTRANCE PE MIT <br /> s�er $Zoo.00 (READ:"General Requirements"on the Reverse Side) <br /> NAME 0 PLICJWT TELEPHONE PAG�f�6EtL FAX /� / <br /> � �1�Y" -�V\" 11[ 1� �(/�l'I � (Q �(/'� � /.V <br /> MAIL ✓� C�1` � V �I STA � ��� <br /> — a� � <br /> NAMEOFPROPER7Y ER ['�11V`� STRffTADDRESS��� CIfY STATE ZJPCODE <br /> 9' � �?�' 11 "` � <br /> CONTRACTORPERFORMINGWORK(IFKNOVVN) 5TR�TADDRESS CfTY STATE 7�PCODE <br /> ,. � J , rsyL� � M IN �53� <br /> 2' MAPN AANION IS HEREBY MADE FOR PERMISSION T0.CONSTRUCT AND THEREAFTER � DRIVEWAY(S) PUBLIC <br /> ❑ STREETS <br /> 3. BUILQING TO BE CO�STF?UCTED: NO � YES � RESIDENCE ❑ SPECIr1'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 PROPERTY <br /> � PHtMIT NUMB63 <br /> 6. BUILDING PERMIT ACQUIRED: ' NO � YES <br /> 7. NPE OF PROPOSED ENTRANCE SURFACE: � BITUMINOUS � CONCRETE ROCK � OTHER <br /> �ocnnaa.-srn�rr� courm.Rono cm <br /> rn� <br /> $. � S�rn�� (�� �- S� �� . <br /> L TION-RURAL � � � � ROAD OR STFtffT <br /> 9' ON RURAL ROAD MILES ❑ ❑ ❑ ❑ OF <br /> DATE PRINTED NAME SI(�JA RE <br /> I'15� ��'� ��.��- �0�-�5�r� �. <br /> TO HELP THE/NSPECTOR,PLACE STAKE WITH A CLOTH ATTACHED, IN THE ER OF THE PROPOSED <br /> ENTRANCE RNL?H/GHER THAN ANY SURROUND/NG VEGETAT/ON. <br /> APPLICANT'S DIAGRAM(IF SITE/CONSTRUCTION PLAN IS NOT SUBMITTED) <br /> �� <br /> ��5 <br /> Q� <br /> . . ; , Sy� �; <br /> ���� �� � � -�� <br /> �,�I`� �`���` ��`5� �,�1 � �`� I`� <br /> �t�'�", .,�,�� � � , �� i <br /> � �- ��%�� � � �p -- �� <br /> � . _ _ - �'�'� <br /> .. _----� <br /> � ---- � . I <br /> �� � � � <br /> 7 � � � Q a r <br /> .��� - -- Complete this form and send all copies to: Hennepin County <br /> � �{� J ��� l� � Transportation Departrnent, Planning Division, 1600 Prairie Drive, <br /> ,,A� �X �� `I�� � ` Medina, Minnesota 55340. Phone: (612) 596-0355, FAX: (763) <br /> GOU• ••�Q �,(i /� ` D V` 478-4000.After approval,one copy will be retumed to appiicant. <br /> �� ��� ��� ��' <br /> R'� �� c �� <br /> � �x`�� <br /> ( a ,,�2� <br />