2000-08-15 WCDofH- Permit No. 0035 and 0036
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DEPARTMENT OF HIGHWAYS
Wrlghl COIll&ly Public Wortr BIlilding
J90J HlrW-'l l.S .Van"
BlI/fr1JII. .Wl__. 11J / J
DRIVEWAY PERMrr APPLlCAnO~
PIRMrr No. i)03s
Jet. r.H. l.S aM C.R. IJ'
rillilpluMiI (6/2) 682.7J41 FAX (6/2) 682.7JIJ
[NFOR~(A TrON NEEDED PRIOR TO INSPECTION:
5" 03
Zip
Daytime Telephone Number:
lc.\l.) 32'3~ '081..
/6 SPECIFIC LOCATION:
Applicant Requests Phone Call: Yes Cl No 0
See Qllot."el S'nu~ ~ J, I f} Y<:. !iJJ Jc.1:
TWP.J2..a... RANGE-4L
( A"P p 4, ('))1.) /I u '1 1S;;2..0 () 0
CENTER OF PROPOSED DRIVEWAY MARKED WITH A LATH? Yes~ No Cl CONSTRUcr{ON DA'fE: OVon ?-,.,...:l-
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APPLICATION IS HEREBY MADE TO CONSTRUCT AND THEREAFTER MAINTAIN THE FOllOWING ENTRANCE TYPE:
Residence Cl Public Street )( Farm Cl Field Cl Commercial Cl
COUNTY HIGHWAY NO.
Side of road driveway to be installed on: N S E @
(Cudo 040/
SEC. -Z......
A MAILBOX SUPPORT IS REQUIRED IF MAIL WILL BE DELIVERED TO THIS lOCATION.
Mailbox suPPOrt needed: Yes 0 No ~ If yes please complete Mailbox Support Application (attached).
DATE PAID: P- -) -0 C> ~
A $25.00 INSPECTION FEE IS DUE AT TIME OF APPLYING FOR PERMIT
(SEE BACKSIDE FOR REQUIREMENTS)
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SITE INSPECTION DATE: ?- J -0 t::>
RIGHT OF WAY WIDTH: t,5 ft. from ccmerline
cm VERT REQUIRED: Dia. } .. Length 9 (;' Ft.
APRONS REQUIRED: Yes # OF BANDS:
ENTRANCE WIDTH: '+ 'I ·
NUMBER OF EXISTING ACCESSES:
RECOMMENDATIONS: F? ..c.,.,.~ ~ ~ ~~~ i
~~A.~_~ ~ 2. P"'" p~
Oe>3S".". ~
,
APPROVED BY: R~
SPECIAL PROVISIONS ATTACHED: Yes
PRICE OF CULVERT $
PRICE OF BANDS $
PRICE OF APRONS $
o J.V N' r:: R.. T c> S:-~PP1'1 vlY~rT
SUB-TOTAL $
SALES TAX $
DELIVERY CHARGE ($25) S
TOTAL $
DATE PAID :4
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As an applicant, I understand that this permit will expire after ~ year. I shall conform to the recommendations above and
to the requirements as stated in the Wright County Driveway Access Policy on the back of this form. In addition I shall
maintain the entrance and take care of all erosion for two (2) years ~ instal:on. Ii:.,
APPlican~nature' ~
Copies to: "'Original/Driveway Permit File I
~pplicant
J!'Inventory Control/Maintenance
o Accountant
o
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IW m
o fJJ
~ 0
--z,. . 4Y
7SS-e;
.....,. ~"....... ......."''-'L'" I
DEPARTMENT OF HIGHWAYS
Wrlghl COIll&ly Public Wortr BIlilding
/90/ HlrW-'l l.S ,Van"
BlI/fr1JII. .Wi__. SSJIJ
Jet. r.H. l.S aM CR. IJ'
riliqluM~ (6/2) 682.7J41 F,U (6/2) 682.7JJJ
fNFORMA TION NEEDED PRIOR TO INSPECTION:
DRIVEW A Y PERMIT APPLlCA no!'
PIRMrr No. ()r) 3 ~
3
Zip
Applicant Requests Phone Call: Yes Cl No 0
Sl!e Qllot."el s'nu~ k' Q hi ky<- S E. -:Tc1'
TWP.J2..a... RANGE-4L
(A"PP4,(')}I.) /lu '1 IS: ;2..o0(J
CENTER OF PROPOSED DRIVEWAY MARKED WITH A LATH? Yes~ No 0 CONSTRUCtlON DA'fE: Of.n ,-,.,...:l-
. ."""0 \
APPLICATION IS HEREBY MADE TO CONSTRUCT AND THEREAFTER MAINTAIN THE FOLLOWING ENTRANCE TYPE:
Residence 0 Public Street )( Farm 0 Field Cl Commercial 0
Daytime Telephone Number:
lc.\l.) 32'3~ '08f..
16 SPECIFIC LOCATION:
COUNTY HIGHWAY NO.
Side of road driveway to be installed on: N S E @
(CUelo 040/
SEC. -Z......
A MAILBOX SUPPORT IS REQUIRED IF MAIL WILL BE DELIVERED TO THIS LOCATION.
Mailbox support needed: Yes 0 No ~ If yes please complete Mailbox Support Application (attached).
A $25.00 INSPECTION FEE IS DUE AT TIME OF APPLYING FOR PERMIT
(SEE BACKSIDE FOR REQUIREMENTS)
DATE PAID: ?" J-i? 1!:> ~
R.t:-
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SITE INSPECTION DATE: 'i? - J - 0 e
RIGHT OF WAY WIDTH: t. .5 ft. from centerline
CULVERT REQUIRED: Dia.) '1f'.~ Length 90 Ft.
APRONS REQUIRED: Yes
ENTRANCE WIDTH: -4 lJ e
~.
NUMBER OF EXISTING ACCESSES:
RECOMMENDATIONS: "R'~........ o....eP ~
<::U:< -.. .It t.ob ~~?' "i- ;J. j;-"- p~ _
Oe>3S ~e:::> 3~
APPROVED BY: Iii? ~ 1>1
SPECIAL PROVISIONS ATTACHED: Yes
PRICE OF CULVERT $
PRICE OF BANDS $
PRICE OF APRONS $
o J..<;:>).J E R /0 .s-vl'~J C"ly<,..."'-
SUB-TOTAL $
SALES TAX $
DELIVERY CHARGE ($25) $
TOTAL $
DATE PAID
As an applicant, I understand that this permit will expire after ~ year. I shall conform to the recommendations above and
to the requirements as stated in the Wright County Driveway Access Policy on the back of this form. In addition I shall
maintain the entrance and take care nf all ernsinn fn, two (2) yearA install:on. e
APp~gnatnr" ~
Copies to: )(Original/Driveway Permit File I
~pplicant
.Ji!" Inventory Control/Maintenance
o Accountant
o