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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 WV 0 G <br /> Township/ Section of Needed Address <br /> Specific Area/Nearby Roads Gp o. kj <br /> Parcel # Q-7 07 17 )- s n <br /> Person/Entity making this request T fte,?"--(= <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 situatio and any collateral information that <br /> you have obtained in this matter. nlyt Sr <br /> (Include any specific request or suggestion that may be important to Staff who are working on the Assignment of the Rural Address) <br /> —7 Q/�9 _ 3 <br /> C:3 + 0 ► w <br /> -14 <br /> Staff person taking in 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 <br /> Form 2006- A 10-10-06 <br />