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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 ..- ` <br /> 'f. <br /> Township/ Section of Needed Address 6/,-----_-_ t /7.2,, 1-\ <br /> Specific Area/Nearby Roads r� -,,,, n C,e „ e-, ; <br /> Parcel # n 1 o C' a c, } `) #; _ <br /> Person/Entity making this request ' 0 4 <br /> L , <br /> Contact Information for requestor `" qy � ?,,„, <br /> < gUGy <br /> Date of Original Request to this Agency(D.te Stamp here) <br /> ' (To be filled in by Planning and Development Staff only) d 1, <br /> Short Narrative of what you know about t s situation, and any collateral information that <br /> you have obtained in this matter. ° <br /> (Include any specific request or suggestion that may be import.it to Staff who are working on the Assignment of the Rural Address) <br /> r <br /> 1 <br /> I dr/v.V-74,. —71SC/ <br /> 3 <br /> t <br /> 1 gam, _ 4- p <br /> E ---> LJ odJ <br /> \ie <br /> I 0 .1 p- 1 <br /> nic4a/A.)e, <br /> I <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 />