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Specific Location/Rural Address Request <br /> (Entire F rm To Be C mpletely Filled Out Before Staff Can Respond to the Request) <br /> y <br /> Date 6°� <br /> Today's D 2 0 ci' <br /> 16r ; SI-8 I z 1 <br /> ownshi. / Section of Needed Address D <br /> Specific Area/Nearby Roads /4 G ry V )ie y I'*. /� <br /> / <br /> Parcel # 0 1/ 2 / 3 r 2080 V <br /> Person/Entity making this request C t 6 c 1\ 1'` <br /> Contact Information for requestor 3 .3 r 2 4 r t 6 k c r , 7 C <br /> c, , PIA - C .5- 310 RIECEIVED <br /> Date of Original Request to this Agency(Date Stamp here) AUG 2 6 2009 <br /> (To be filled in by Planning and Development Staff only) <br /> Short Narrative of what you know about this situation, and any collateralDMOUNINIUMNING&DEVELOPMENT <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 /> 145 0 e & 1 , <br /> Vet I ? ey e-e A ili L fc IV E./2 6 4 1 <br /> -z 6 4 I-] 4 pya y <br /> �" ( A i 1 1 r, /1 <br /> (/L b v Y <br /> 3 0 <br /> Staff person taking in this request 06 <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 />