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/DOT bJ.E. PERMITS TEL:l-B12-582-1454 Feb 05 98 11:36 No.O01 P.02 <br /> * ' MINNESOTA DEPARTMENT OF TRANSPORTATION, ' ~. S~jction L,Z. ~.. c,- ~ -- Hwy. m x/ <br /> <br /> ~"" No. __ ' _ No. <br /> pr type appHca{ion. Fill out 3 copie;, sign end mail to Minneioto Department of Tranrm, por ration. · <br /> <br />ACH TO ALL 3 COPIES, A SKETCH OF THE PROPERTY, PRESENT AND PROPOSED DRIVEWAYS AND RELATION TO TRUNK HIGHWAY, <br /> SKETCHES SHALL BE DRAWN TO SCALE WHEN REQUIRED BY THE ENGINEER. <br /> <br /> Acldres~ ~,~j.,...~ ] Tel. <br /> Addre~ --. ~ ' ' ' ITel. <br /> <br /> (cArcie one) (Specific ro~d, landmark, nr reed ifleerse~ion) <br /> <br /> 'Yes {Type) ~~ , <br />,we~ ~ Commurcla[ (S~c[fy Type) ~ ropose~ Puhhc Stfee~ . he <br />he ~TemporafvorI, Pr0p0rw ~ PIo~xed~r [ Dis,ence,rom,n,ro~hi~wayto*ron, <br />ling be ~Permenent. , ~ is in ~ Un,letted Arce . of building, or front of pump island is j {~ ~ ~et. <br /> <br /> is Show f~ & inches ~ Level No. el Present DHvewew t Date Driveway ts needed <br /> <br /> -'xecl Location of Propel. ed <br /> <br />Exact Location of Pre,eat <br />8way to Property ~ /~ '~ <br />e, the underdgncd, herewhh mak~ application for~frmi~flon ~o construct the access drlvew~y a~ ~ho above location. MI~ drlvewoy 1o he constructed to conform <br /> <br />~ny othe~ aff~ted governmental <br /> <br /> p~ NOT WRITE BE~W ~I~.NE <br /> <br />ccESS DRIVEWAY OR ENTRANCE PERMIT <br /> <br />NOT VALID UNLE~ <br />3NED AND NUMBEREDJ Authorized Check, Money Order or 8end No,. <br /> <br />....... No Deposit Requir0d ...... <br /> <br />trlct <br />Only <br /> <br /> A d0poslt of $ <br />Check, Money Order, or Bond shall accompany the application. <br /> <br />,_, payable to the Commissioner of Transportation, in tho form of a Certified or Cashier's <br /> <br /> Thi~ OePOtit Mede by*. <br /> <br />Deposit will be returned to applicant upon completion of item ~ (rev0rse.., slda.) <br /> Special Provisions: <br /> <br /> All work to be completed_ / <br />er Permit ia approved: /' <br /> <br />Whi~e Jo Applicant <br />P/nk [0 D~r. Main& Of/icc <br /> // <br /> :~, . q,... <br /> <br />/ <br /> <br /> State to furnish ._ , <br /> <br /> <br />