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2cD Co <br /> 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 (2,2403 <br /> Township/ Section of Needed Address IUt( kt ii n <br /> Specific Area/Nearby Roads , r . e • 44. <br /> Parcel # blO 9 -053-40,0 .. 0 <br /> Person/Entity making this request %akar ' h • <br /> • <br /> Contact Information for requestor <br /> Date of Original Request to this Agency(Date Stamp here) 41Z03 ,/E,„ <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 /> I <br /> CA Z�I 1.5 S F 12- <br /> ctuty,6)1/4 Jima WILT <br /> ibe pickuvek 10-1\mi <br /> Staff person taking in this request $14°41141/. <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 l0-10-06 <br />