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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 1 2 C/0 2 <br /> Township/ Section of Needed Address Spy.'ny�c )-e- /2,6 <br /> Specific Area/Nearby Roads =r Ad2 <br /> Parcel# D6 D 1 2-6 2- - e(,60 - y <br /> Person/Entity making this request .Si-a/1 5z A" e"ki., U-1.9/ , ' •1{j , /I e.}` <br /> Contact Information for requestor Ve-irc y /Jj,/b-_-- <br /> 26'c) // <br /> / 11 o e k s� <br /> %--AX�,Y ) 14v2 5?7// <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. N.e.. ,,� G,p$1/1-e <br /> (Include any specific request or suggestion that may be important to Staff who are working on the Assignment of the Rural Address) <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 />