Henn Co Driveway permit-1998 - Laserfiche WebLink

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HC 532.9 11/97 ENTRANCE HENNEPIN COUNTY PUBLIC WORKS � �- PERMIT FEES 320 Washington Avenue South PRIVATE $50. Hopkins, Minnesota 55343 r TEMPORARY $100. COMMERCIAL $200. APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT STREET $200. (Read "General Requirements" reverse side) Name of applicant t ',+ ';.) , 3C 1•.-CSE.ti f .,L' Phone Address - � 'Ji,�12 (city) T (state) i (zip code) Name of Property Owner�. *t � `�-,yrl' Address 1. Contractor performing work (If Known) i _ �! ("I r1ER tL1_- Phone -f"2177— 'L Ili-, 2. Application is hereby made for permission to construct and thereafter maintain: Driveway(s) Public Street(s) 3. Building to be constructed: ❑ Yes 11 No ❑ Residence ❑ Commercial (Specify Type) i� 4. Driveway or street will be: E Temporary ❑ Permanent Date proposed entrance will be needed: • 5. Is the property: 1-11 Platted ❑ Unplatted Number of present driveways or entrances to property: �Je-Ad 6. Building Permit acquired: ❑ Yes ❑ No City Permit No. 7. Type of proposed entrance surface. ❑ Bituminous o Concrete ❑ Rock ❑ Other B. Location (Address) (Co. Road) (City) 9. Location, if rural: Miles of (N.,S.,E.,or W.) (Road or Street) Dated Applicant's Signature Printed Name TO HELP THE INSPECTOR, PLACE A STAKE WITH A CLOTH ATTACHED IN THE CENTER OF THE PROPOSED ENTRANCE,HIGHER THAN ANY SURROUNDING VEGETATION. APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted) Complete this form and send all copies to: Hennepin County Public Works Planning Office, 320 Washington Avenue South, Hopkins, Minnesota 55343. Phone: (612) 930-2548, FAX: (612) 930-2727. After approval,one copy will be returned to applicant.