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'� F-tc532s s�9s HENNEPIN COUNTY PUBLIC WORKS Permit No. � �' ��
ENTRANCE 320 Washington Avenue South
PERMIT FEES Hopkins, Minnesota 55343
PRIVATE $50.
TEMPORARY $50. APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT
COMMERCIAL $100.
�: STREET $100. (Read "General Requirements" reverse side)
�f � Name of applicant —_—t �_� � Phone _': _ -!�:'��
6 Address '` rald i. :�.. �, [s
(city) (state) (zip code)
='!�
Name of Property Owner ` ' ;' � ` ' '` ' .;.� Address ' ` � � °
1. Contractor performing work (If Known) Phone
2. Application is hereby made for permission to construct and thereafter maintain: : �Driveway(s)~ Public Street�s)
3. Building to be constructed: o Yes d,,No � Residence o Commercia► (Specify Type)
�
4. Driveway or street will be: � Temporary Q Permanent Date proposed entrance will be needed: ��
(Permit expires one year from date)
5. Is the property: W Platted � Unplatted Number of present driveways or entrances to property:
6. Building Permit acquired: m Yes � No City Permit No.
7. Type of proposed entrance surface. � Bituminous k�Concrete � Rock � Other
H. LOCBLIOf1 (qddress) � (Co. Road) i , �` � (City) �
�
#
� : 9. Location, if rural: Miles of
(N.,S.,E.,or W.) (Road or Street) t
Dated Applicant's Signature
Printed Name '
s�
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TO HELP THE INSPECTOR,PLACE A STAKE WITH A CLOTH ATTACHED IN THE CENTER OF THE PROPOSED ENTRANCE, HIGHER THAN ':;•�
ANY SURROUNDING VEGETATION. �''
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APPLICANT'S DIAGRAM - (If piot or construction plan is not submitted)
,:
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(Complete this form and send all copies to: Hennepin
County Public Works Permit Office,320 Washington Avenue
South,Hopkins,Minnesota 55343. Phone:930-2548.
After approval,one copy will be returned to applicant.)
:,
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HC 5329 back(3i93)
1. Appiications for commercial and industrial driveways or driveways servicing parking iots or garages with five or
more vehicular parking spaces musi be accompanied by two (2) separate layouts, Such layouts must meet the
requirements of the Rules and Regulations Establishing Design Specifications for Driveways along the Hlghway
Systems of Hennepin County, Minnesota. Copies availabie at the Hennepin County Public Works, 320
Washington Avenue South,Hopkins,Minnesota 55343.
2. Applications for entrances serving private residence, farm or parking lots of less than five vehicular
parking spaces need not submif a "site plan, but shall make an appropriate sketch in the space
provided on the front of this sheet. Such sketch shall generally locate the entrance, indicate its
dimensions,and relate to property lines.
3. No work shall be started until application is approved and permit issued.
4. If the installation of this driveway makes it necessary to work on the roadway,traffic must be protected;lights,signs
and proper barricades must be in place.
5. It is expressly understood and agreed that this permit is conditioned upon not placing any materials
on traveled portion of the County roadway and that restoration of all disturbed area becomes the
responsibility of the applicant. The area disturbed must be restored to its original or to a satisfactory
condition.
6• After driveway construction is completed, persons requesting installation must notify the permit office that such
work has been completed and ready for final inspection and acceptance by Hennepin County.
7. No changes or alterations in entrances may be made at any time without written permission from the County
Engineer or Representative.
8. Approval of this permit does not deny the County Engineer the future right to revise, relocate or
close any entrance to expedite the movements of vehicular or pedestrian traffic.The County retains
the right to close said entrance(s) at its discretion, based upon the necessity for traffic regulation and
controL
9. Existing driveways are not automatically perpetuated. In the event of a change in land use or a major
change in the traffic pattern of the existing facility, new driveway applications may be required by
the County.
� �?'lf�2-27-1997 ��28 PUBL I C �ICRKS 612 93� 26'90 P.J2i02
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