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Specific Location / Rural Address Request <br /> (Entire form must be filled out before staff can process the request) <br /> L, l/ Z Z 9 IMPORTANT <br /> Property Owner: Date: <br /> p Y , <br /> Applicants must provide a site <br /> Current Mailing Address: plan, draw► to a rrzeasurab/e' <br /> :'scaler showing <br /> Street ,°Lot lines & dimensions' <br /> \Any extsting'or proposed, <br /> City, State, ZIP -,....„„.7-7 mgres Iegress to the property <br /> Distance from lot lines to the <br /> Phone#/ Email Address: <br /> existing/ proposed ingress <br /> \`Rny approved Driveway„ <br /> Permit inforr>ntatfon from the <br /> town`or county <br /> � xl.�, n A <br /> A A� �A <br /> \v C me ,,,, i_S <br /> z\` \\ \t Township/Section of Needed Address: <br /> 3 9 <br /> E(„2._Specific Area / Nearby Roads (e.g., road names, distance to intersection, etc.): <br /> Tax Parcel Number:OCo6 -34 -8oato - 9 <br /> 5'7 U <br /> Additional Information: <br /> Office Use Only S ff person \ �` ..\,,: o,\\` ; ` AZoning�ermit# ,\ <br /> \\ \\\a \\�\ iZ�.\ �\ a \\ �y� \ \i <br /> 6M\ ;Lise \ 1 \� 747 < 7777 t �\`\ :4, �l\\*. \ ��\��• ` �l\r*\ <br /> A A <br /> \ <br /> \. <br /> �' <br /> \AA <br /> \�� A� AV VA� \� 7 <br /> A A� � \ A,- A A�A *V 1A V � 1 a k�\ \ A <br /> A 2 y �vlax , ,0: a A� \ A A . A *\ Z \s � Z <br /> �ti i a te 7Ae V \r x v A aOz � � V AZi 1 ` $a . \ . WA A V S a A 4-4V 7 ,tA �.: 0 4 : V A7 , -. A AA A3\7Z v ' Y <br /> A� 'y , A sti AV VAt h 7tiZ� %*ay� � vA�_ \VV \1��`w � j v A,�. ,.. A A 7 t vv aA\AW w \ as_.�vv \ ti k � A \<: v\ A \A A V y y� � VA�\ ` V \* te: w 4 � t V A \\Z� A; <br />