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Specific Location / Rural Address Request <br /> (Entire form must be filled out before staff can process the request) <br /> Property Owner: Date: IMPORTANT <br /> Current <br /> mailing Address: Applicants must provide a site <br /> g plan, drawn to;a measurable <br /> scale showing <br /> Street : Lot Imes & dimensions <br /> �ny exsting=or proposed <br /> ingressfegress to the property <br /> City, State, ZIP 1� i�. . <br /> Distance�from lot lines to the <br /> Phone#/ Email Address: <br /> existing/proposed ingress <br /> ,Any approited Driveway <br /> r'er infor atiol from the <br /> \V�. �� \\�a e VV� a as C vn�. <br /> towrr�or county <br /> Township/Section of Needed Address: a , a ,� yv <br /> Awv yyvvv v V <br /> yv . <br /> Specific Area / Nearby Roads (e.g., road names, distance to intersection, etc.): <br /> Tax Parcel Number: - - - <br /> Additional Information: <br /> Office Use Only;Staff person r\ . �� \\ \� \\ \�\ \Zoning errni}# <br /> \.\. �\ �\, \ . \.\� e aS. . ' \ a ��\\�\ �\\1a\\a n .. \C\\�q \\a :\ Yc\\a , <br /> \. \ �\-\ e.:\`` as'i\ \�\, \ xy,a.. \\\\ 4�\ \. a C\\`a�, . \..::a:ti\�� .:..- '\:.\a \ \ .\ <br /> \ \ C \a x\ ,x\ � ��\\ ��\\\\\\�a \\\��� \c� .�\\�\\\ \�\rte \� \ \ �t�\y� \ <br /> .: .\.. ,a a \ \\ � \ F. Cy, �\,3\\ Q Y.\` \tea.\`\\a. \\ \\\� \\ \\:y „- \ <br /> \ :e \\.� \� \.a ,, \ \ \ z a \ .aka \ \\. \ x <br /> \.\arc \\\\\ \ \ \\ \ \ <br /> \:�..\a T a-c� a. s .�\\\eta i��\\ ���.\ \ :.v. �....�c \�\'�fi\\�\ .�. \ �.\��� F... i . 3�� \\ti,� <br /> \:' �\ �. \ \\� �. .+"E'�,:'\�::r` �� � �\?a\:`��\�\\,.anti\"\ ; i\\\- '\ �\� \ ���\\\\ ,� \ a \ ft v; <br /> \... \\�.� \ . :\�\y\ \rte ,.-.\. �\�: �n.�.Ca,.�\ .�\..� \ �..:a... ''�\.C�\��\.\\ ,:�'�` `\ \ \ <br /> \. a Nti .'\\, \ �� V\� \ �\ t '\ �\\:\\\@\YF e'- vat\:: a 3.ait . :?-g r�.�'\ _ \ .I _: , \ <br /> \ �\�a as \\ \ � \\\.a.� s\ a 3 ,.� \. i� '\` �i ��\: \�c\�c�. \ \\. \�` \ . <br /> � \t\a as 4i \ c\ `� ..� ti �'.y IN,,q. 4-tk,"^% w£� \N U* `.\\R,\ti qk - '\ a i -a \\,\\ \ <br /> � \ �- A \ � x a �a "mac\\ : \ \\ \\ �\ l \� ;\ <br /> � , �a -� \ .t;;,,\`a.. 4 C. " 4t4.`\� \k\ ''; .\ fit.\1���. .skkZ\\. ril:A)�4 ''\ \ \ - \i C\\\\ \ \ <br /> v . .i �\ . �. waft . av AA <br /> ,.. A vA h6 v A\ e.• VA Kvv \ c a \a A` \ <br /> Approved Address ' ,,M.�v -�.� Date, v°� <br /> y <br />