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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 g // 0 t <br /> Township/ Section of Needed Address 1`<`,1"hL --61 ZS <br /> Specific Area/Nearby Roads S4- 1) /3 <br /> Parcel# cs 1 0-- <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 situa ion, and any collateral information that <br /> you have obtained in this matter. (V-€A.J- F <br /> (Include any specific request or suggestion that may be important to Staff who are working on the Assignment of the Rural Address) <br /> t <br /> I — 4/ Q / y <br /> �-?A0 N + <br /> 1116* 43-3 <br /> Staff person taking in this request A./v-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 />