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Specific Location/Rural Address Request <br /> fig (Entire Fo To BJO <br /> mpletely Filled Out Before Staff Can Respond to the Request) <br /> Today's Date 6 / e <br /> Township/ Section of Needed Address C b / ! G(K()U G <br /> Specific Area/Nearby Roads'. S A-RC) I0 <br /> Parcel# O-7 f '- 5 '13 S S C ( <br /> Person/Entity making this request 17I1 A-rr — 0 f Aj cr <br /> Contact Information for requestor <br /> 7\ /t) / <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 /> !,J or /657 S --,-4iv 1i o RD <br /> -.4- (,, , A- =-) (Ai 6 F a ita-0 i - -) <br /> ...._:, 0 4 c /-3-- / C, 6, q ._ n- R--a 6 ND <br /> 6 77_,A <br /> c1-4S <br /> ___ <br /> _____ <br /> • <br /> Staff person taking in this request C it-S <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 /> Am. <br /> Form 2006- A 10-10-06 `� <br />