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<br />3377 North Rice Street <br />Shoreview 1 Minnesota 55126 <br />484-9104 <br /> <br />. r ~ f <br /> <br /> <br />Permit Fee <br /> <br />$100.00 <br /> <br />APPLICATION POR DRIVEWAY OR STREET ENTRANCE PERMIT <br />(Read "General R.equirements" reverse side) <br /> <br />Name of applicant <br /> <br />Roseville Good Samaritan Center <br /> <br />Phone 631-1616 <br /> <br />Address 1415 West County Road B Roseville <br />(city) <br />The Evangelical Lutheran <br />Name of· property owner Good Samaritan Society Address <br /> <br />MN <br />(state) <br /> <br />55113 <br />(zip code) <br /> <br />2177 Youngman Ave.,St.Paul, MN <br />55116 <br /> <br />1. Contractòr performing work <br /> <br />(Not selected yet) <br /> <br />Phone <br /> <br />~ <br />2. Application is made to construct and thereafter maintain: <br />Ï9 Driveway(s): 0 Residence or f8l Commercial OFubHc Street(s) <br />Entrance <br />3. Drivewaý or street will be: L7Resurfaced OReconstructed (widened) Æ?/N ew Construction <br /> <br />4. Driveway or street will be: OI'emporary MPermanent <br />Date proposed for construction August 1994 <br /> <br />5. Building permit acquired: DYes !l§No City Rosevi11e <br /> <br />6. Number of driveways or enfrances to property: <br /> <br />Existing <br /> <br />o <br /> <br />Proposed 1 <br /> <br />7. Type of proposed entrance surface: &Bituminous DConcrete <br /> <br />8. Width of proposed entrance(s): <br /> <br />18'-0" <br /> <br />9. Location <br /> <br />1415 West County Road B <br />(address) <br /> <br />Roseville <br /> <br />MN <br /> <br />55113 <br /> <br />(city) <br /> <br />10. Location, if no address <br /> <br />feet of <br />TN, S, E or W) <br /> <br />(road or street) <br /> <br />Place a stake in the center of the proposed entrance, higher than any surrounding vegetation. <br /> <br />It Wet the undersigned, herewith accept the terms and conditions of the regulations of the Ramsey <br />County Engineer and agree to fully comply therewith t~the sa ·srac.tion of t1Je Ram...¥y ç.9un~ <br />Department ot Public Works. IÍ ' ~/~...... ~ <br />./') Ie:; ¡,./ Applicant's I "..)j"'-"'<.. tv . ð <br />Dated :J /'/ b I / Signature ;ø. . . "1 ~/! ' ~k <br />t { f v /~-~ <br />, <br /> <br /> <br /> <br />REvmWED BY <br />Design r<~:;~~<-\ <br />Maintenance ~ <br />Environm ental <br /> <br />DATE <br />':; -2.4..£;' 4- <br />:r~t%-q"¡ <br /> <br />CULVERT SIZE: <br />APRON: <br />COMMENTS: <br /> <br />" x <br /> <br />WBJ/ptcl- 10/89 <br />FORM DRIVEWAY PERMIT <br /> <br />It is expressly understood that this permit is conditioned upon replacement or restoration of the <br />County roadway to its original or to a satisfactory condition. It is further understood that thi.s <br />permit is issued sUbject to the approval of local city, viIIage or township authorities. (~ I <br /> <br />~/DENIED: . \ <br />~OUWTY DEPARTMENT OF PUBLIC WORf'S <br /> <br />, By y~ r So-L Date sit·..., Jft.( <br />