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<br />.'-' -\ Ramsey County Publk Works Road # f Segment: __,-12~~l-~2=_~?J4.m______,
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<br />(651) 266-7tH8 (fax) Performance Bond: __~=-:---=-':~..:.=..-::=--=-=-=---_____,
<br />www.co_ramscy.mn.us/pw/pcrmit~. Other Fees: o_.._'___~___
<br />.- -.. - --- u_.. - - - . .. ... .---- ofiici-;ruse ri~;i).-
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<br />Allplication for Dri\"cwav or Street Entrance Permit
<br />(Rt:ad "Ciencrall'rovisiolls" on reverse side)
<br />}>Iease Print , ,
<br />Name ofPropei-ty Owner:/!/;-;' /X/,-,i'ii Phone Number: kJi-CX_ S(f f
<br />. ..." . . -~Z!.~..,"i-':>~---' ."'. ./7 ,: ._______.n '~J' . 1 .--.?i-.=,-~~~.-:::::=,~"
<br />Name of Pmne Contractor. i !"~~'n~':'!~,) <,':"'0 '" i', " '-, '.,' _ ,~, Rt.:glstratlOn Number. ..l;\,..I'-.-:::~~/(L..__ n_
<br />1. Joint Applicant(s) & Registration Number,s):
<br />Contractor: , '" ... ,____ Registration Number: '" ______ ___ ,
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<br />Contractor: ,___ _ ..,_, __ Registration Number:_ ,______n___.. ,_
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<br />Contractor: ,___, u____ Registration Number: ____, ____ .._______, , ,..._ ,_
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<br />2. Application is made to construct ami thercalkr maintain: _ ..____ "
<br />Driyeway(s) LT__:J Resiuential L..u(,:-] Commercial L____J Public Street(s) L_~
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<br />3. Driveway or street will be:
<br />Resurfaced L__,l Reconstructed (widelled) l --'~__..] New Construction r.~~
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<br />4. Driveway or stred will be: /i ".--. J " '
<br />l'--'" '--\ .. -' . t,~f...,/?"/.: / - ,,'t..Y" ,I
<br />Temporary ..m_.. j J'<.:'i 1i,;Hi '.' ,'~_,_,_j ! ),lle ,:)f proposed cOlisii'uct!on;;," r/,(ti..:.::::....':: / .. ~ ~' /
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<br />5. Building permit acquired: '{es r=::_'.. I No I' '~] City_..______._____________
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<br />6. Number of driveways or entrances to propt:rty: Lxistin!,' I '(;~ '-,"] Proposed [~L.~
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<br />. Ty.pe surface of proposed entrance: .",BillllIlil,lOUS I, ',' >>, 11 Concrete r---~~~:] Other ,__.._____,___ ,.."", ....__
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<br />: ~~:::::Pro~;'td'h/2~-;~~,,:,:,,'"" >-~!' '_ 4;2~{~&<r)-==
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<br />10. Location, ifno address: .. __.. , Fed .." ,_ ..,..__,________ of ..,,_____ ..______..__
<br />- "" iN,S,E,"') (road or street)
<br />11. Start Date:
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<br />To aid the inspector in locating the driveway. place a stake: ill the Ct:llll'r of the proposcd entrance, higher than the surrounding
<br />vegetation.
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<br />I, We the undersigned herewith accept the terms and cnllditions sd limh in the Coullty Ordinance # 2001-287. Public Utilities
<br />Commission restoration standard plates ]X 19.9900 through 7S 1l).l}l)~O, (icneral or special provisions of the Ramsey County Engineer
<br />and agree to fully cO~Df'tyl~>>'ith tp:th,J-";:~:ir~i(),I~9.rd~,:.I?~Vl1~.J" ('ollnty Department of Public Works.
<br />, A~"./ ---- --../" 0" ,.-/" "/ -,
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<br />- . . . 1;/ ._;::...._....:. ...::..:--.......'........ ....._ " ~ "/_
<br />Apphcant SIgnature,: ~r ",-,-,-<0 o':-:: ';; ---:: Date: //' ..:.-/ ~ C y;
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<br />~"-=~~'__' ~~~~_ ,:-:::,~~_ -- -~~'~,,, ,-~"--,~", ....~~ ',04" -.." --, ,~:::::-'~,=-=-:===~_~~"",""...~=.,""...- '...'-~~--'~~_~,"..'. ',"",~~~~~~.~~~,
<br />Official I Jse Only
<br />Reviewed by: Dale Culvert siz.e: X
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<br />Design ff'it'71s' , Apron:
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<br />Mamtenance 7.t ..li----~ _ /"-'/~:~/;:"~'~,?_ Commcnts:
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<br />Traffic
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<br />It is expressly understood that this pennit is conditioned upon rcplacement or restoration of the ComIty Right-of-Way to its original
<br />condition as shO\m in Standard Plates 7819,99()O to 78 19.9950, It is further understood thatthis pennit is issued subject to local, city
<br />~ShiP authorities. This penn it expires 30 days from the date of aj!pf<<n:aJ...,\ i
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<br />'- APPROVED____i DENIED RArvL~E\' COl f!'JTY DE~' Rliz:i\? 1)r OF PUIILIC 0RKS
<br />\ .. ,- /... 'r 0: /".
<br />By: /~,::~.::.::=::-:--"/:- ,- ;.,~;.( Date: / Z .F) ~L:/
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<br />1 '.dncs'.Diivl.,,",1:l.)' Permit Apr ke.... 1 dlX. .~ 10/1512004
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