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Specific Location/Rural Address Request <br /> ((Entire Form To Be Completely Filled Out Before Staff Can Respond to the Request) <br /> Today's Date 7/3/( 0 9 <br /> Township/ Section of Needed Address IZ7 4-(A- <br /> Specific Area/Nearby Roads 1-1 — <br /> Parcel # 0S / 0 - - )--Q <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 /> Short Narrative of what you know about this situation, and any collateral information that <br /> you have obtained in this matter. f n; vv ,e o <br /> (Include any specific request or suggestion that may be important to Staff who are working on the Assignment of the Rural Address) <br /> NS%� <br /> ))'Ll 1 /Ar-4 , 7 <br /> L4- 56 <br /> si 4 9Y <br /> 5.1N9)- <br /> � U <br /> M <br /> (`/1 <br /> Staff person taking in this request )� 3-- <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 />