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ACCESS TO COUNTY <br /> PERMIT APPLICATION Permit No.: 13 - <br /> Sherburne County Public Works L=_31 - !L2 <br /> 763-765-3354 <br /> Applicant Name Address: Tel.: <br /> Conty.actQr/Contact Name: Tel.: <br /> City,Zip: <br /> Proposed Access in: Township (circle one) (Specific road,landmark,or intersection) <br /> Section a3 Township :93 Range 2.6, Property Address: A)Iq <br /> All access vvidCbu are limited by Mn|NOT Standard Plate No. 9008]0 <br /> [—h <br /> Residential/Plat Access shall bul5`min. &24` max. PIN: /V�&� Ca� ~ - ' --_.,� . <br /> F�h <br /> Commercial, Industrial or Agricultural Access 32` maximum Development Numc: ���� <br /> Public Streets are on a case 6y case basis S(rourY4umo: <br /> 1,we,the undersigned,herewith make application to construct an access onto a County Highway and that said access shall be constructed mmnnt/bu <br /> current standards and cnoddivux of Sherburne County yuh|in YVv,bx. Ibx applicant oboU comply with all applicable m\eo and ,ogu\n|ioux and <br /> ordinances io effect nt the time ofissuance. Construction of the access shall not be started until the application is approved and the permit issued. in <br /> the event that the ovnot,omivn has not been completed by the expiration date, the permit bxmmxm uu|i and void, the Access 8vuo Fee <br /> forfeited and n Right vfWay Violation will be issued. Right i will b forwarded h County <br /> Attorney. The cv^dibonmunUotodvu the back of the permit,any o,ovm»zoyi d <br /> provisions <br /> included in I panying supplemental letter. <br /> Date Signature of Applicant(s) <br /> DEPARTMF,NT UT ONLY $10.0.00 Res./Agr.-$500.00 ConimAnd./Plat/Street Resilftatial/A r. Permit Fee Paid: $ <br /> Inspection Date: Expiration Date: I I Access Bo ce Paid: ($250.00) <br /> Mailbox Suppor *d($75.00) <br /> or <br /> lil'3 trnl <br /> Culvert Required Yes No Diameter&Length: TAL,: $ <br /> Number of Bands Required: Date <br /> Comin/Ind/Plat/St. Permit Fee Paid: $ T6Vs 00 <br /> Approved Denied Q Signature: Mailbox Support Paid($75.00) $ <br /> Traffic Signs @$225.00 each: $ <br /> Final Inspection: Date: DATE BOND FEE RETURNED: <br /> AFTER ALL WORK& RE'STORATION IS COMPLETED -SIGN & RETURN A COPY OF THE PERMIT TO: <br /> Sherburne County Public Works <br /> Date Access /kCto: Permitting Agent <br /> ` 425 Jackson Ave <br /> Applicant Elk Rivet,MN 55330 <br /> Rev. 3/26/13 <br />