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• <br /> • <br /> Specific Location/Rural Address Request <br /> (Entire Form To Be Completely Filled Out Before Staff Can Respond to the Request) <br /> Today's Date g1,2_61001 <br /> Township/ Section of Needed Address p i i it I d- 3 <br /> � + <br /> Specific Area/Nearby Roads n y� Pan, RL. r <br /> Parcel # OBOB -3c3 " ` 0.3G-0 <br /> Person/Entity making this request �6(CGtN P1 V�/c d � S 11 <br /> Contact Information for requestor J a n F(c111 Zen <br /> +6 �+ be00C�l <br /> Date of Original Request to this Agency (Date Stamp here) e /Zi-1 t 10 9 <br /> (To be filled in by Planning and Development Staff only) I <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 /> rc 7-0 vt-e [O L 1 � �s d S <br /> c_0r0Qr <br /> _ I <br /> g-- V C-41 \9 SizAr 'De . <br /> arc <br /> wA <br /> ti <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 />