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Specific Location/Rural Address Request <br /> (Ent' e Form T Be Completely Filled Out Before Staff Can Respond to the Request) <br /> Today's Date ( 09 <br /> Township/ Section of Needed Address -/.^ d-b <br /> Specific Area/Nearby Roads NCB r w as- D r o�.ti. Sl /T2 <br /> Parcel # 6 ( n -_a 6 q o 0 0 -"3 <br /> Person/Entity making this request)• 1) -' tfN <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 /> 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 /> C 0 <br /> Staff person taking in this request /10, ∎ <br /> Requestor shall provide a site plan, drawn to a measurable scale, including lot lines & lot <br /> dimensions, and any existing or planned ingress/egress to the property, and the distance <br /> from the lot lines to the ingress. <br /> Filed by Town & Section <br /> Form 2006- A 10-10-06 <br />