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--, <br />-- R&MSBY COUNTY DEPARTMENT .0P PUBLIC WORKS <br />• 3377 North Rice Street <br />Shoreview, Minnesota 55126 <br />484 -9104 <br />Permit . No. <br />Permit Fee <br />APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT <br />(Read "General Requirements" reverse side) -77/ - 76 $% hh <br />Name of applicant 4i-15 %hyj «rC h Phone 47/9 -74/57 l{/ <br />Address <br />&z e- Pei 8 2— /r 6. /WO. <br />(city) (state) (yip code) <br />Name of property owner <br />(fiver /,S /iritmers -4 Address /?77 fi rstr • <br />1. Contractor performing work <br />Phone <br />2. Mplication Is made to construct and thereafter maintain: <br />Driveways} 0 Residence or Q Commercial QPubiic Street(s) <br />3. Driveway or street will be Q Resurfaced L'teconstructed (widened) QNew Construction <br />4. Driveway or street will be QTem�$�y_ afI "ermanent <br />Date proposed for construction '4 <br />5. Building permit acquired: /''Yes QNo City Gitt (e Grote k <br />6. Number of driveways or entrances to property: Existing / Proposed c <br />7. Type of proposed entrance surface: j ltuminous QConcrete <br />8. Width of proposed entrrance(sh .201(3a1Wes44ii j <br />9. Location I p z t , E • Co . R, . b?_ &i±ft,o C4.gLdk <br />. (address) <br />10. Location, If no address feet <br />(city) <br />of <br />(N, 8, -g or W) (road or street) <br />Place a stake in the center of the proposed entrance, higher than any surrounding vegetation. <br />I, We, the undersigned, herewith accept the terms and conditions of the regulations of the Ramsey <br />County Engineer and agree to fully comply therewith to the satisfaction of the Ramsey County <br />Department of Public Works. <br />Dated " 5 FQ Applicant's <br />Signature fr. j/7 <br />Design <br />Maintenance 4/yl <br />Environm ental <br />REVIEWED BY DATE <br />CULVERT SIZE: <br />APRON: <br />COMMENTS: <br />It Is expressly understood that this permit is conditioned upon re• 'cemet or re oration of the <br />County roadway to its original or to a satisfactory condition.; It is further understood that this <br />permit is Issued subject to the approval of local city, village or township authorities. <br />�PPROVED/DENIED: <br />RAIiSEY COUNTY DEPARTMENT OF PUBLIC WORKS <br />WBJ /ptd- 10/89 <br />FORM DRIVEWAY PERMIT <br />By <br />Page 81 <br />Date <br />