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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 dair Z Q 3 <br /> Township/ Section of Needed Address W,( 0 <br /> Specific Area/Nearby Roads L. // N <br /> Parcel # O ( $ — 061 14 - O63 15-2,1-c7 <br /> Person/Entity making this request T i SA $1 L y /l t1/LO ZC L 1i)11 Ter' <br /> Contact Information for requestor o-$ —6 35- ! -l' <br /> 603 - 69s- S -83 <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 abo t/ situati�on,r y collateral information that <br /> you have obtained in this matter. `-� <br /> (Include any specific request or suggestion that may be im rtant to staff who are working on the Assignment of the Rural Address) <br /> r vv Li <br /> r DANE s ° <br /> Q -2, 0o 2 / l / JUL 2 s 2008 <br /> CO �' ZONING <br /> � v <br /> t� ds C3►Vl alO� <br /> C.� a / <br /> r C� v <br /> Staff person taking in this request <br /> et,s c.11 <br /> p g n re q <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 1AI I `A s 0 r 6 <br /> Form 2006- A 10-10-06 <br />