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RAMSEY APPLICATION FOR DRIVEWAY OR STREET ACCESS PERMIT PERMIT NUMBER <br />COUNTY RAMSEY COUNTY PUBLIC WORKS b a `i0 <br />Public Work!; 1425 Paul Kirkwold Drive, Arden Hills, MN 55112 RD SEG ©/� <br />(E-mail) yl ermits;cvra _ic�co�inty�us _f_L'C�--- <br />Phnnp-6S1-266-7186 Fax:651-266-718B <br />Applicant Name Company Name <br />Phone No. 612-369-2746 <br />Brian Jansen Boulder Contracting <br />Email: brian@bouldercontractinglic.com <br />Billing Address: Street City State Zip code <br />16522 Wake St NE Ham Lake TKM N 55304 <br />Property Owner: Brian Jansen Phone Number: 612-369-2746 <br />i nrATln Ai nc DDnanSED DRWEWAY OR STREET ENTRANCE LULAI IUN, IF NU AUURC]a <br />Address or Intersection City Number of Feet (N,S,E,W) of Street or Road City <br />2557 County Rd I Mounds View <br />APPLICATION 15 MADE TO CONSTRUCT AND THEREAFI EK MAIN I AIN <br />Type of Entrance <br />Driveway or Street will be <br />Driveway or Street will be <br />Surface Type of Proposed Entrance <br />❑■ Residential Driveway <br />❑ Resurfaced <br />❑Temporary <br />❑a Bituminous <br />❑ Commercial Driveway <br />❑ Reconstructed (widened) <br />Q Permanent <br />❑ Concrete <br />❑ Public Street <br />0 New Construction <br />❑ Gravel/Rock <br />❑ Other: <br />I <br />I <br />❑ other: <br />Number of Driveways or entrances to Property <br />Width of Proposed Entrances: <br />1: 16 ft. 2: ft. 3: ft. 4: ft. 5: ft. <br />START DATE: <br />TBD <br />Existing: 0 Proposed: 1 <br />(1), the undersigned, herewith make application for permission to construct the street or driveway access at the above location. The said street <br />or driveway access shall be constructed in accordance with the regulations of Ramsey County Department of Public Works and to any special <br />provisions contained below and on page 2. (2) This permit is conditioned upon replacement or restoration of the County right of way to its original <br />or satisfactory condition. It is further understood that this permit is issued subject to the applicant's compliance with the rules and regulations of <br />the local city and/or township authorities and any other affected governmental agencies. (3) It is expressly understood that this permit as issued <br />does not in any way imply an easement on public or private property. This permit does not convey any property rights within the right of way to <br />the permittee. <br />Date: <br />APPLICANT MUST Applicant re: <br />10/15/24 <br />SIGN PAGE 1 AND 2 <br />v UU IVU I vv Rl I C DGLV VY <br />PER Authorization <br />Asa condition of this permit, culvert is required: Dyes o Culvert Size: XJ C/uullvert apr s required Yes 0No <br />SPECIAL PROVISIONS: Nmjfa <br />tJ i <br />Proper Traffic Control Devices and Procedures Shall be used. All traffi c ntrol devices, icades, flashe <br />etc. shall a furnished by the <br />permittee and shall be in accordance with the most recent edition of a Minnesota M al On Uniform Traffic Control Devices and the MNDOT <br />Temporary Traffic Control Zone Layouts Field Manual. <br />Permission is hereby granted for the construction of the access as described in the above application, said access shall be constructed in accordance <br />with the requirements special provisions listed above and on page 2. <br />prizedSigna e: ate: P RMITFEE: Payment: <br />I ❑ CheckBilled ❑Waived <br />a � Pale 1 of 2 <br />