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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 od / 3 lj SW <br /> Township/ Section of Needed Address -77;cr.,. C. /ci ‹,n <br /> Specific Area/Nearby Roads � ,� �C �"W <br /> Parcel# 0 C /01 ' Y ' g /30 ` © <br /> Person/Entity making this request rz,- /z---// <br /> Contact Information for requestor <br /> 23 - 2- co <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 /> IQ-G-(14> tf c i) 12._t_ <br /> 7 <br /> R-0 0Aiel <br /> C� IS <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 />