HomeMy WebLinkAbout1969-10-14 Hennepin Co Application for Driveway PermitIIC-II-81 Rev. lY-67 HENNEPIN COUNTY HIGHWAY DEPARTMENT
APPLICATION FOR DRIVES Al 0H ENTRANCE 1'F.1011T Permit No. 3671
(For Construction of Private Ihiveway or Entrance from and to a County Road)
1 � I L- J7 7 f') I / :� /c mac. t,,� i_ 'E 7_, Vii✓
(Name of Applicant) (Street Address) (City & %ipcode) -(Phone)
2. 4_
(Name of Owner) -- _ (Street Address) (City $ "ipcode) (Phone)
3. County Road No. Side of Road
I N., .., E.. or .)
4. Location: miles of _
( N., S., :., or R'.) (TAI.. Co., or Twp. Road)
S. Is the property: 9/platted? ❑ Unplatted?
4. Purpose of Driveway: VResidence. ❑ Commercial (Specify Type)
Yex
7. Building to be Constructed: No Date proposed entrance will be needed:
8. The driveway will be: ❑ Temporary. Permanent. 9. The Land is: Vligher, ❑ Lower, ❑Level with the Road.
1
10. Number of present driveways to property:
For Site Layouts see the general-quirements 2 and 3 on the back of this sheet.
To help the inspector locate the driveway, place a stake in the center of the proposed driveway, higher than any surrounding brush ur weeds, with
a cloth tied to it.
I, the undersigned, herewith accept the terms and conditions of the regulations of the Hennepin ..ounty Highway Department and agre o fully
comply therewith to the satisfaction of the Hennepin County Highway Department.
Dated /
ADDlle anl'1 Jrinal Yfe '0"
APPLICANT'S DIAGRAM
Driveway Layouts shall be 20, 10, or 50 feet per inch.
Of Roadway
Size, Length and Type
of Pipe Delivered: _
Date of
Delivery:
Inspected by:
Driveway was found to be in:
ENTRANCE CONSTRUCTION (Do Not Write In This Space)
Date:
❑ Satisfactory
Ej Unsatisfactory Condition.
0.5' Min. Depression
FILL Sl:( TION, DISTANC LS AND GRADILNIS INDICATED IN RIiD �) i�'� Place Culvcrr If Necessary
AUTHORIZATION OF PERMIT
In consideration of this agreement to comply in all respvcts with the regulations f heJ oar tment co.efing such
operations, permission is hereby 'yf�111r tQriv�eril�ib� Will driveway to he in
accordance with the regulations a�' n'�R
SPECIAL PROVISIONS: are rLanA wn w
It is expressly undersimicl that 1r,. ul-n replaa cmem ur rr..turation of the Bounty Ilighway to its original or to a
satisfactory condition.
Design Engineer
(Complete this f•+rm in quadruplicate and send all copies to:
Hennepin County highway Department, Maintenance Office, - - Traffic Superintendent
320 Washington Avenue South, Ilopkins, Minnesota 55343. — -- - �—
Phone: 935.3381. After apprvcal, one copy will be returned -.
to applicant.) ----
,Mainibnance Superintendent
IIFNNI.PIN COIINTI IIIGIISAY DEPARTMENT