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�.� 2 old SIV . 02- <br /> Specific Location/Rural Address Request <br /> (Entire Form To Be Completely Filled Out Before Staff Can Respond to the Request) <br /> Today's Date / / frci <br /> Township/ Section of Needed Address Rf1&ttc 2:2.— <br /> Specific Area/Nearby Roads 0 C c WC. Zd <br /> Parcel # — G I 0 2.23 q 0 <br /> Person/Entity making this request k 6 ut j s <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) (1 J•3 I l©er <br /> Short Narrative of what you know about this situation, and any collateral information that <br /> you have obtained in this matter. <br /> (Include any specific request or suggestion that may be important to Staff who are working on the Assignment of the Rural Address) <br /> 14— eft_ao,rec e 01S 39 I2_ OLD <br /> Gl� yr Ltl art v∎ Clam Li-2_ <br /> 2 ,C <br /> 1 <br /> �s �� <br /> — tomb <br /> Staff person taking in this request ,J J1 kJ V Ld <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 <br /> Form 2006- A 10-10-06 <br />