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Specific Location/Rural Address Request <br /> (Entire Form To B Completely Filled Out Before Staff Can Respond to the Request) <br /> � <br /> Today's Date � )-- a CI <br /> Township/ Section of Needed AddressS .9 <br /> Specific Area/Nearby Roads J B �� r-� j(-- <br /> Parcel # 0 SS f ) S5 ) c 3 0 <br /> Person/ Entity making this request �`j QS�� ►� <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 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 /> o � <br /> c, <br /> Q <br /> Staff g <br /> erson taking in this re uest <br /> p <br /> Requestor shall for provide site plan, dawn to a measurable scale, including lot lines & <br /> lot dimensions, and any exis i : . . : -. -d 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 />