HomeMy WebLinkAbout1976-11-29 Hennepin Co Gas Installation Permit #321iz
"C 0136 HENNEPIN COUNTY
HIGHWAY DEPARTMENT
220 rech,npon Ar nue Saurh
H-016-, Minnesota 55347
APPLICATIO � OF UTILITIES
I
NER-M
Ceawty Road No. i4 Rr
JAN S 1977 Permit Nt. _
Municipality Ula):10 �— ----•—
LOCATNJM Application is hereby, made far paritiuion plan, construct and the4after maintain�a I !'t Crrency !'111 ynry rensil
along or acnes County Highway No. 34 ( af) 3445 i's, s itio "o:'..:
is
NAME of applicant 'lir lesotn Gas Cow any ph,,, 372-4338
Address 71111 Linden Ayonue nest !li:r:onrnits, "i u,ezota 4t);
CITY STAT[ ZIP Coo[
Party w ovgoniantion parferming week 1 : 5 11) Dyc
Address !i12FA Lis BiIOYP
CITY STATa Vo CODS
Pherte (fiuslilen) ` ir:*7 7.4 above Phone (Emergency) i r_- 'yr. �
1. Will detouring of traffic be necessary? itiO If eecesttry to detew traffic, describe suggested rode:
2. AERIAL CONSTRUCTION • Submit detailed print showing typo and lecofien of installation.
2 UNDERGROUND CONSTRUCTION
TRAVELED SURFACE
SHOULDER
CONDUIT
INSTALLATION
CASING
E] Multi duct file
Pipe class
Steal pipe
❑ Transit*
Type bedding
Other type
❑ Clay or concrete
Service type
Site
Q Steel, cast or plastic
Size
Depth
Other
Depth
4. METHOD OF INSTALLING UNDER ROADBEDS (II span trench, explain why necessary)
T3,41111ering ❑ Jacking ❑ Opew trench
S. AREA TO BE DISTURBED
TRAVELED SURFACE
SHOULDER
BOULEVARD
p Concrete
❑ Bituminous
❑Sad
❑ Blhmtinous
❑ Cravat
❑ Field Gnat
Otho
Other _
Other
STRUCTURES
❑ Bridge ❑ Curb i Gutter ❑ Trees
❑ Box Culvert ❑ Sidewalk ❑ Shrubs
❑ Pipe (Concratt, metal) Other ❑ ►IoeHnge
S. The owfoce will be restored and ell work under Chit permit will be complated on•164466&i' �(ovo!+er 29t 1076
DATZ
(PERMIT IS VOID AFTER THIS DATE)
If Mark comet be completed within dates specified, a written request for permission of *-tension must be mods, to the Hennepin
county Nighwoy'Doportment.
Except It, the negligent acts of the County, its agents and its amployeos, the Utility or Pentlttes shall assume all liability for end
saw the County, its agents and its ootployoos, homeless from any and all claims for damages, actions w counts of action arising
out of the week to be done herein and the continuinq uses by the Permitrae, including but not limited to the piecing, constructing,
reconstructing, maintaining and using of said utility -JW this application and Permit (w construction.
(1, Mo) the undersigned, herewith accept the torn■ and conditions of the regulations as laid down !; the County of Memopin and
agree to fully comply therewith to the satisfaction of the County Highway Deportment.
Organization 'Il`IAL'SOTA GkS C04PAYY
B, Data 12-�J-76
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