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11 <br />CITY OF LITTLE CANADA DEPARTMENT OF PUBLIC WORKS <br />515 Little Canada Road <br />Little Canada, Minnesota 55117 <br />484 -2177 <br />APPLICATION FOR DRIVEWAY OR STREET ENTRANCE PERMIT <br />(Read "General Requirements" reverse side). <br />Name of applicant /14 Tes "--^ ,f%/¢n%n/c2aSri %,o Phone <br />Address 3 2.6÷1/A- L.cn .,a_,( o- 4412, A <br />(city) <br />Name of property owner /L1/ St. c n-Fy &tc+y •deMao•A3dress <br />Cor-r $ «).J <br />1 . Contractor performing work rz.A- rr•rc..n-J Z ?hone <br />Permit No. <br />Permit Fee <br />.4c S <br />'2714 S-3-// ? <br />(state) (zip code) <br />G.( a) <br />2. Application is made to construct thereafter maintain: <br />/ /Driveway(s): (Residence) o / /Public Street(s) <br />3. Driveway or street will be: / /Resurfaced / /Reconstructed widened) <br />4. Driveway or street will be: / /Temporary' <br />Date proposed for construction <br />Wermanent <br />5. Building permit acquired: / /Yes <br />/No City <br />New Construct <br />Maly <br />J-a . ari <br />Permit No. <br />6. Number of driveways or entrances to property: Existing / Proposed <br />7. Type of proposed entrance surface: <br />8. Width of proposed entrance(s): <br />9. Location 2277 (oia+., <br />Bituminous / /Concrete / /Other <br />r CJ Z L eStki e. L-Ct ect <br />(address) <br />10. Location, if no address feet <br />(city) <br />(N, S, E or W) (road or street) <br />Place a stake in the center of the proposed entrance, higher than any surrounding <br />vegetation. <br />I, We, the undersigned, herewith accept the terms and conditions of the regulations of <br />the Little Canada Engineer and agree to fully comply therewith to the satisfaction of the <br />Little Canada Department of Public Works. <br />Dated <br />.377K(9 3 <br />Applicant's G %G* <br />Signatur <br />Design <br />Maintenance <br />environmental <br />It is expressly understood that this permit is conditioned upon replacement or restoration <br />of the City roadway to its original or to a satisfactory condition. <br />REVIEWED BY DATE <br />CULVERT SIZE: "x <br />APRON: • <br />COMMENTS: <br />Page 7 <br />APPROVED /DENIED: <br />LITTLE CANADA DEPARTMENT OF PUBLIC WORKS <br />