Contact Information

Applicant Name

Current Address

City

ZIP

State

Email Address

Applicant Phone No

HomeWorkCell

New Structure Information

Proposed Building:
HouseMobile HomeBusinessOther

Township

Road Name

Property Owner

Adjacent neighbor's addresses and mailbox locations (same side as property or across the road)

Notes/Comments


  • The address will be assigned based upon the location of the approved access point.
  • All driveways will be evaluated for the appropriate permit requirements.
  • Applicant will indicate the approximate location of the structure being addressed.
  • The address will not be assigned until access has been approved.