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Specific Location/Rural Address Request <br /> (EEntir Form To Be Completely Filled Out Before Staff Can Respond to the Request) <br /> Today's Date / ( 5/0 9 <br /> Township/ Section of Needed Address 6( I ' c: .--,pl 3 <br /> Specific Area/Nearby Roads h P it J,.- oc\ R3 <br /> Parcel # 0 c 7 c O.- O c�(-) e <br /> Person/Entity making this request <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) <br /> o Narrative of what you know about this situation, and any collateral information that <br /> you hav- obtained in this matter. <br /> (Inclu., y specific request or suggestion that may be important to Staff who are working on the Assignment of the Rural Address) <br /> 6S CZ) -V 1 0 = `s-C9gA9 _ I3 LI. S <br /> --k'Rs`v'i 13LI . S 4 N -ei 6o , 3gLI <br /> S <br /> N,,As ()chi <br /> „... . e. s 1- <br /> - - ; q 4111b <br /> in Staff person taking this request -, ''\ <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 e)/ (1 0 w olc -->r--- <br /> Form 2006- A 10-10-06 <br />