<p> 911 Address Request Form</p><p>Please Return to 407 Main Street South, Room 307 Towner, ND 58788 Or Email to [email protected]</p><p>Date ______</p><p>Owner or Resident:</p><p>Name: ______</p><p>Current Mailing Address: ______</p><p>City ______State______Zip Code______</p><p>Telephone Number______</p><p>Building Location: (Please include a sketch if possible) </p><p>Township Name, Section and Quarter : ______</p><p>Parcel ID: ______</p><p>Road that permanent driveway will branch off of______(ex:73rd ST N) </p><p>Avenue or Street that driveway will be parallel with______(ex: 1st Ave N)</p><p>Distance and direction from parallel road to driveway______(ex: 300ft East of 1st Ave N) </p><p>Closest Neighbor______</p><p>Closest Neighbor’s Address______</p><p>Are there any current structures on the property? yes no</p><p>If yes, What are the structure(s)?______</p><p>If no, what will be built? ______</p><p>When will it be built?______</p><p>______Official Use Only______</p><p>New Address Assigned______</p><p>Date of Notification______</p>