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<br />Feb 10 2006 7:03AM <br /> <br />HP LASERJET FAX <br /> <br />'l <br /> <br />ACCESS TO COUNTY mGHWAY <br />PERMIT APPLICATION <br />Sherburne County Poblie Works <br />7&241-'7800 <br /> <br />p.9 <br /> <br />,. Permit No.: 06 -1'1 · OSI <br /> <br /> <br />ConttaCtOl: <br /> <br />In: <br />Hipway No:~ <br /> <br />Sectioa..9- ToMllhia~~ Ranp'.:1:JL ~Atkbs.: 1~OD 1 <br /> <br />AIIau.t wtddIIB" ~ by MJIbOT StudanlPlate N.. ,GOOD <br /> <br />Cl Roaidmtilll AccMI aball be IS' mitliznum to 24' madmum PIN: <br /> <br />~ ,..~. ..,.. T_...........s...t " A -:.....t.,;_I.AceclI.....I.l"J. '_i~' ..' :i:ieYol' M. <br />)liA .~....-...,"~ <<~.-~ . , ."'!f'.. _ ~_.. ~..,.IIDP..._... <br /> <br />CJ Public. Streets are on . Calle by case bul. Street N8Dl8; <br /> <br />I. we. the UIIdereIpeci, lu:n:with JDlIb appJicatloo to constrUCt III ~ onto a CouPty Hip..y aDd tIIIIt IBid K'Ce8I sba11 be <br />COQ~ to meet the ~ atancI8rda ad eouditioDs of ~ Covnty. 11Ie IIpp1kaDt sba11 ec)mply widllllJ ...... rule. <br />and repladODl aad onliltancol iu eIfect at die lime of iUuancc. Co~D of the ICCOSS ....1 DO& be 1ItIatoCI..d1 tIYI appJ1ca1iorl it <br />approved and the permit I8tued. ID the .~ tb8I1be GODJtrUCIlOD has 110I bleD twly ~ by the expirMion cIafe, die .-mil <br />~ DuD and yoJd aa4 .. AOQCII BoDd rce 1ba111lOl be mumed. 'I.'IIe cmd~ IDe JIlted OIl.... 'bM:k or.... ...........,. <br />8Iided pl'8...... "IN"'," III _ _c:....,~~..1aaIr ~ ~ ~ pen__tt. <br /> <br />Date: / /J1I'I" ~..efA~) ~ ~, ' <br /> <br />DEPAR'l'MKNTUSE ONLY: <br />$SUO PrIvate <br /> <br />_.,-..........~~~:~w~:...:.. "M <br />~.. .....",.. <br />Ii" Sl00.00~~.)'i <br />\.~"i!.:. - .:.~-::.. ._.~.;./y77~~~.:....::. :~e;;' <br /> <br />Inapc:ctiOliDato: \ \ ..... t, <br />W W"Jdtb f'tomceatedine: <br />O:dvcrtRequlred 0 Y. ~ ND <br /> <br /> <br /> <br />Diameter " J,.euJlh: <br />Price IJneal Foot: $ <br />per '. <br /> <br />Number ofBucIa RCqllimt: <br /> <br /> <br />sa AppI'O\WI <br /> <br />Q DeDted <br />Siped: <br /> <br /> <br />ConuucnlS: ' <br /> <br />~; <br /> <br />""'''.<.7 "~..,;r,' M~d <br />~....-~.1 <br /> <br />,p../e . <br /> <br />PInaIIU~ <br /> <br />De_ <br /> <br />pod.... Permit Fee Paid: <br />AeeeIs DODd Fee ftPd: <br />MaUbox Support PaJd: <br />TOTAL: <br />I <br /> <br />'. <br />Date A: Ck II: <br />Oslwn 0IiJy: <br />B~ It .-\JlIODIIpetet: <br />DeIi.WiIY CIdrp: <br />S.. Tax: <br /> <br />D8te a ct Ii: <br /> <br />TOTAL: <br />"J <br /> <br /> <br />~~. .... Permit Pee Paid: <br />A.cceM BOIId Fee PIIicJ: <br />StDp Sip: <br />Addlti.OQIl Sips: <br />. $100.00 ach: <br /> <br />~ <br />o :~ <br />~L: ~ S (,of)J7() <br />Il?> <br /> <br />Date a ct II: <br /> <br /> <br />BOND PEE REl11.RNBD: <br />D4\TB: <br /> <br />SIGN AND RB'1'URN TII'IA WORM All'TItR. "'I..I~ WOIlK.IS COMPLETED <br /> <br />o <br /> <br />Date Acceu Completed: <br /> <br />Applicant <br />Sipatun:: <br /> <br />R8bun to: s.......... Couaty Public Worb <br />AUn: .... BeIUDI <br />'25 J..... Av.... <br />Elk Ilh'er, MN S5338 <br /> <br />,. . ., <br />