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