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Address RequestNEW ADDRESS REQUEST FORM Date: 03/05/2021 Name: Dale Hansen Building Permit Number Legal: Subdivision: Checklist: Newly issued address: RN -2021-00075 Lot#: Tract 1 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 i�rrJfyr 1 wy� �Iz 689-59 970ZOZ #1V3fOMd SNN"ARMNO3H0 --'- 7ZAMtlI1Nyf L31VO O131dI SNN US NMVM4 A=50P VPJIN MmullOIS 101-11 ��'��f' LZAZ'L ANV(IaiHj moa'11-4D689SZauo33" 1 -m -a 9£L9108£'ZOb IPO Sb089 E'l�"1aN `P��PP O Z£4-,qgq-i 90rL 'VA M83N d031VIS3111 JO SMYI 31l M30NN 710A3AN'f1S �l.4YLl a1l.4Ltl.\ �I.I -O 1 ONVIoanisiJ3MAV1a VwV l ivHi ONV N0157AM3df1S lJ 6 ImiOawd103MI,3AMSSlHLIM03W A803aVd3Md ^1TiTO'](.i�p�y Ay 5tlM1Id8Wf1000 A3AMl1S S1H11VH1 A3LLM30 A83M3N1 vl.L ^VJ IL 771/Vl aouno)auaao � (S)•49'ES4 U qq< �yOF aOSA Uw !NO ❑� z a �\aW i Iti x i yo 3_rc� =o=x A-= w -hgud �3Q +�+i"ciTo F<=n❑ cam c7 z zzzOm¢¢ap da—.0 Zaisp m OwWo��¢rczUVw�O�w y6¢ V b Q Z»�MZZOwt nl z '.�E 2, 30102 Nt Uyo`0o �wi�m a.l =goag3w LLsy°3XOS �5�00 (SidCZbL Al90Al.WN w � y_ �iN els �a 6S'LM(S).5VLU3L M.ZL.LLeZON �7 I%I•ES'EZ£L IS)bb'EZEI 3.LS11°Z08 IFI),09'L99 I3Ib4'149 __ — -- i_ '— (S]6S'LK yyl.LLdOS (H}LCS591NI.L9'E59 (H)fi9'E59 _ (S),Y6 id' 3°6511.WS (S)•49'ES4 � „ {•Yi w^3� m � � �$ i Iti x �� M F^ tl p (SidCZbL Al90Al.WN ZZZ as _I I z � y _ �— b Pe;nMns—(�Ilwoaa�'rr�.oE'Les �7��s �z— (y},S6yg9Z(N)SSZb4LIHl£fiZb4L IHI.b(YE49Z ISIA6y49Z M,.9bbL°ZON I f I Im I \ Ih I Uif �. I a tz I IN},bSZ06 s m I ®Va Zy¢ IHI.64'LLbI (NI�04'LL4L IS).L6'Ll4L ---- - (5).E['ar4Z ASLbI°ZEN EE =1� w�0 �10 la� ^hr 3 « W O Z x