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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 /> R , <br /> Today's Date q- �y, 0 e <br /> _ :.,.„„ <br /> Township / Section of Needed Address r, <br /> ) -v ry A <br /> Specific Area/Nearby Roads (X//41--rte/" / r T- r°I f iv 4 <br /> Parcel # 660 ? L)- id `( Q v :+„%::, 6 <br /> Person/ Entity making this request D 2 — L1 . 6-7 V <br /> 1 N <br /> Contact Information for requestor 1 C 11-S <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 /> a"5712--ckc -r a<✓ ik_ SCf <br /> 0,4- 'i <br /> ?'d-- ,), <br /> Staff person taking in this request C l/S <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?OM- A in-in-n6 <br />