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LAND SERVICES <br />BURNETT COUNTY GOVERNMENT CENTER <br />7410 COUNTY ROAD K #120 <br />SIREN, WI 54872 <br />UNIFORM COUNTY ADDRESS SYSTEM <br />OWNER/RESIDENT <br />Name: Thomas Denman Trust <br />FEE: $150 <br />Payable to: Burnett County Land Services <br />Date: 9/11/2018 <br />Mailing Address: 3675 Jeffers Parkway NW <br />City: Prior Lake State: MN Zip: 55372 <br />Telephone: 952-200-7731 <br />E -Mail Address: tdenman@ymail.com Please contact Northland Builders Inc with inquiries <br />715 2 <br />BUILDING LOCATION: <br />- 59-3257 <br />north land 001 @centuryteI.net <br />Legal description (from deed): That part of Gov lot 7 Desc 504-520 <br />Section: 11 T: 40 N, R: 15 W <br />Township: Jackson <br />Road Name: Voyager Rd <br />PIN No.(from tax stmt): 07-012-2-40-15-11-5- 05-007-019000 <br />My closest neighbor's name and address is: <br />28957 Vovaaer Rd <br />I am located (circle one) NORTH, OUP,AS <br />AS rom my closest neighbor's driveway. <br />I am on the (circle one) NORTH, WEST s' e of road. <br />Is there a structure and what is it? none <br />Is your driveway INSTALLED in a permanent location? (circle onef—Y—E—S-1 NO. IT IS MARKED WITH LATE <br />**IF ANSWERED NO — CONTACT THE LAND INFORMATION E TO DISCUSS** <br />**New driveways may require a permit. For driveways on Town roads contact the local municipality. <br />For driveways on County roads, contact the County Highway Department. For driveways on State <br />roads contact the Department of Transportation. ** <br />(OFFICE USE ONLY BELOW THIS LINE) <br />New Residence: <br />Not Numbered: <br />Number Change: <br />Explanation: <br />NEWLY ASSIGNED ADDRESS IS: <br />Address Number Road N <br />City. <br />TAForms & Policies\Forms\CURRENT\ADDRESS_APP_MAR2018.pdf <br />Paid: Ck.No. <br />Receipt No. <br />GPS measurement -date: <br />Drive: N: <br />E: <br />Bldg: N: <br />In Novus Letter Sent <br />