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Specific Location/Rural Address Request <br /> (Entire Form To Be Completely Filled Out Before Staff Can Respond to the Request) <br /> Today's Date r / /0 <br /> Township/ Section of Needed Address o -d <br /> Specific Area/Nearby Roads <br /> Parcel# 0 6c-m6 a 13° ° r <br /> Person/Entity making this request y'- r' ckn <br /> Rd <br /> Contact Information for requestor <br /> Date of Original Request to this Agency (Date Stamp here) <br /> (To be filled in by Planning and Development Staff only) <br /> Short Narrative of what you know about this situation, and any collateral information that <br /> you have obtained in this matter. e N w 6 a�J N rte. <br /> (Include any specific request or suggestion that may be important to Staff who are working on the Assignment of the Rural Address) <br /> ptc <br /> J <br /> ► 3� 0 — 95= '3� $ <br /> 3'1.S <br /> So <br /> - 3 s; °1 i-}s <br /> k ,, t1 ` . ) <br /> ioss� x 50 I <br /> Staff person taking in this request )4'm 1^S <br /> Requestor shall for provide a site plan, drawn to a measurable scale, including lot lines & <br /> lot dimensions, and any existing or planned ingress/egress to the property, and the <br /> distance from the lot lines to the ingress. <br /> Filed by Town & Section I.l o , S ) <br /> Form 2006- A 10-10-06 <br />