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Specific Location/Rural Address Request <br /> (Entire Form To Be Completely Filled Out Before Staff Cori Respond to the Request) <br /> Today's Date S-S - 0 ' _ .- <br /> Township/ Section of Needed Address 7 t''AJ [2 12. 2 <br /> Specific Area/Nearby Roads e _ ,_ -. 4 / /4 h/' d 1 . - ci rJa c 1-re-c1 <br /> Parcel#01 le/ <br /> Person/Entity making this request £ C • ez [t s F' /J- LEg r zoAJ (4.,//Et Its <br /> Contact Information for requesto ►fr, �� f e <br /> i,oc? <br /> Date of Original Request to this Agency(Dula Stamp here) <br /> (To be tilled 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._A jI�v CQ,�,��•.�,c4 tip 7-0 E.2 <br /> (include any specific request or suggestion that may be important to Staff who are working on the Assignment of the Rural Address) <br /> • <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-c)6 <br />