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Address RequestNEW ADDRESS REQUEST FORM Date: 06/29/2021 Name: Joseph &April Grim Building Permit Number Legal: Subdivision: Checklist: Newly issued address: RN -2021-00087 Lot#: 9 Added to map in 911 Township book Make a copy of map and give to Teresa to create a sign (HOLD) Entered address number into Data Base Entered address into B1uePrince MSAG notified for newly created Street name Final inspection completed Sign installed (contacted the Road Dept.) Cadastral Current mailing address; Rural Living in WA, Co. Brochure Spread Sheet Send Letter, e-mail, or fax to: Faxed map and new address info to City or Village Owner Post Office School Fire Department American Broadband Black Hills Energy OPPD PSAF / County Dispatch Assessor Election Office General Contractor In i It a m r ��r C H go s° n � ax ii2 w�3 N Hmg„ �3HHO ILI.4t.£S. LG+S V a � 'w AOI{] � a � � o n 5L9 .oa.oN U z Q CL LLL op uj rc s rc r a sr� w 'Szif `moo ,� w -tit_ n o s LLI app HH- M1 j Iff �g��N �I�Ifll a 1 � 5{5 o t tr w S ILJ m uQ LU n9 ad II.I Qz .SL4 00.0m o m ,VbCL l to L�aa uNnp] O tiff ti� to p n� zQLu� 4� J Ili p � N � r ❑ N LLI SL