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Wf,SNlJNQT0N'r.QQJW�,Y PUBLIC WORKS DEPkRTUE63—b <br />T .ar'g--tGI.-L 11680 Myeron Road north o Stillwater, Minnesota 550$2 <br />Phone: (651) 430-4313 o Far.: (651) 430-4365 <br />COED yr <br />/-IPPLOCATOOR FOR <br />Attach a drawing of the property, present and proposed accevs and relation to the count%, road and any <br />Permit Edo.. [ , i <br />CSAH/CR <br />Right -of --Way <br />Municipality <br />Storm Sewer 0. <br />Permit Pee $ <br />ARpiicant Address (Sheet, City, Zip) Tel. f <br />Fi o i.s ` ,:G�i3 �rj �' 1 ' 4 ; S� d ®• ,� i u! ' `,� 11 , �1� C <br />�w <br />Property Owners Address (Street, City, Zip) Tel. <br />legal Description of Property (abbreviate if necessary) end Street Address: <br />Purpose of ❑Street Driveway <br />Access: _ OCommerciai (Specify type) , <br />Will the OTemporary or Prop <br />Building be: ermanent Is in: <br />No. of present I—XJ <br />Fc <br />driveways to property: <br />Date needed: -� <br />9 AM <br />Estimated completion date: !A - I .®® 1A <br />❑!Meld Entrance <br />Is a Building to ❑No <br />de constructed? �aYe: <br />or Distance from center of highway to front <br />:d area ©Subdivision of building: feet <br />location of proposed eway t pro <br />Exact location of present driveway to property <br />OFFICE USE ONLY %# _ <br />deposit of $� payable to Washington County Treasurer, in the form of a Company Check, Certified or Cashier's Check shall accompany the <br />application and will be returned upon final acceptance by the County. No interest shall be earned or paid on this deposit. It is the responsibility of the permit <br />older to notify the County when the work is completed. Check No. -- - <br />(1) (We), the undersigned, herewith make application for permission to construct the access at the above location, said access to be constructed to conform <br />with the regulations of Washington County and to any special provisions included in the permit. It is agreed that all work will be done to the satisfaction of <br />Washington County. It is further agreed that no work in connection with this application will be started until the application is approved and the permit issued. :t <br />is e°.:pressiy understood that this permit is conditioned upon replacement or restoration of the highway to its original or to a satisfactory condition. It is further <br />understood that this pampit is issued subject to the approval of local city, village, or township authorities having joint supervision oyer said street or highway. <br />D to Signature of Appli4rtt <br />11 ®O NOT WRITE BELOW THIS AREA NII <br />ACCESS DRIVEWAY PERMIT AUTHORIZATION — PERFORMANCE REQUIREMENTS <br />As a condition of this permit, culvert is required: Yes K, No Cutvert Size x Culvert aprons required:[ nA Yes ❑ No <br />Storm Sewer presen¢: ciYes ❑ No Locate by date: <br />If the work is not completed by the date given on this application, the cost of completing unfinished construction by County forces may be deducted from the <br />deposit. In the event that coqatruction has not started by this date, this permit becomes nW1 and void an the permit fee shall. be forfeited and the deposit shall <br />be refunded. � `� �,//J ,� <br />SPEML PR6VISIONS: Ft �. ,4ic�'laY`a. " 141 A�4 r i i <br />Permission is hereby granted for the construction of the driveway as described in this application, said driveway to be constructed in accordance with all <br />regulations of Washington County and subject to the above requirements and spedcl provisions. <br />All work to be cgrpleted by <br />App <br />Authorized <br />Public Works <br />Copus: ❑Applicant OCounty Engineer C]Municipalityy <br />Revised 912013 <br />RPermWFormskfto s Permii.doe <br />