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Specific Location/Rural Address Request <br /> (Enttiire Form To Be Completely Filled Out Before Staff Can Respond to the Request)/ <br /> Today's Date ( / 0 9 <br /> Township/ Section of Needed Address BI 0 V )' I <br /> Specific Area/Nearby Roads <br /> Parcel # 0 c>6 ° <br /> Person/Entity making is request n►^-n e\r\ <br /> fed <br /> Contact Information for ref s _ <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. 1ti e w ►- R NI' <br /> (Include any specific request or suggestion that may be important to Staff who are working on the Assignment of the Rural Address) <br /> f <br /> C)CiSz 115 <br /> 1�.)S+ -1SALA. <br /> so <br /> 1�e SCR <br /> 4-9 -?7S-1 13 � - s z s <br /> IOSS� <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 IS/ S <br /> Form 2006- A 10-10-06 <br />