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<br />' 'Hc ssz9 HENNEPIN COUNTY PUBLIC WORKS Permit No.
<br /> . �` � � 320 Washington Avenue South
<br /> Hopkins, Minnesota 55343
<br />= APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT .
<br /> (Read "General Requirements" reverse side)
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<br /> Name of applicant Phone '
<br />� Address
<br />�,, (city) (state) (zip code)
<br /> Name of Property Owner Address
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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: Drivewayls) Public Street(s) �
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<br /> 3. Building to be constructed: G► Yes o No d Residence � Commercial (Specify Type)
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<br /> 4. Driveway or street will be: o Temporary � Permanent Date proposed entrance will be needed:
<br /> 5. Is the property: � Platted Q Unplatted Number of present driveways or entrances to property:
<br /> 6. Building Permit acquired: � Yes q No City Permit No.
<br />� 7. Type of proposed entrance surface. � Bituminous � Concrete o, Rock o Other
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<br /> 8. Location
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<br /> (Address) (Co. Road) (City) j
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<br /> s�,: 9. Location, if rural: Miles of -�
<br />�,i' (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. ..
<br /> APPLICANT'S DIAGRAM - (If plot or construction plan is not submitted)
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<br /> (Complete this form and send all copies to:Hennepin County 1
<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.) a
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