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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 <br /> Township/ Section of Needed Address )(-)-/ <br /> Specific Area/Nearby Roads ,iQ D f o�"., Sl /-1-e ✓"` <br /> Parcel # 6 ( C, n - <br /> Person/Entity making this request). V <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 /> e7j-- <br /> C r\I 0 /(:), <br /> Staff person taking in this request S <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 />