Request For New E-911 Address Assignment - Aitkin County
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1Aitkin County E-911
Request for NEW E-911 Address Assignment
(
.’)
Your property address, if already assigned, can be found on your tax statement under ‘
property description
*Name of Applicant: _____________________________________________________
*Mailing Address: _______________________________________________________
*City, State & Zip: _______________________________________________________
*Contact Phone Number: _________________________________________________
E-mail Address: _________________________________________________________
(*Required Field)
***Please Read and Fill Out Completely and Accurately***
E-911 designation of the Road your driveway intersects: ___________________________________
On which side of the road is your structure? North_____ South_____ East_____ West_____
Including your building, will this driveway service more than two Residential or Commercial buildings? Yes___
No___
If you answered YES to above, how many houses/businesses will share this driveway? ___
*Parcel number (PIN) of the property: (e.g. 00-0-000000) __________________________________
Will mail be delivered to this address? Yes___ No___
Is the driveway already in place and usable? Yes___ No___ (If YES, how long has it been in
place?______________________________ (If NO, please answer question below.)
If driveway not yet in place, how you will mark your driveway
location:____________________________________(e.g., lath, stake, ribbon, etc.)
Note: It is the applicant’s responsibility to obtain driveway location approval from the Jurisdictional Road
Authority, (State, County or Township), before receiving an address.
You must include an accurate sketch of your driveway location in relation to the structures you listed above,
&/or intersections in the area, on the back of this sheet or on a separate sheet of paper (NOT a site plan!).
An un-marked driveway will NOT be processed. Failure to mark your driveway with something
distinctive such as; name, stake lathe, ribbon, paint, etc., will delay address assignment.
Please note that this form & payment will be returned to the applicant if detailed directions
to the driveway or location markings are not provided. Moving the driveway that you
indicate above, for any reason, will necessitate a new application & fee, and will result in the
assignment of a new address. Assigned addresses are subject to change to comply with
Aitkin County’s addressing system.
Please make $55.00 check payable to Aitkin County for E-911 address assignment
After the fee has been received and this form is completely and accurately filled out, please deliver this form
to the Aitkin County GIS Office at 209 2nd St. NW Room #204 Aitkin, MN 56431. Your address will
be assigned and you will be notified of your address, under normal circumstances, within 1-2 weeks of
receiving this form. The address sign will take approximately 12 weeks to arrive at the Aitkin County Highway
Dept. You will be notified by email or phone when your sign is available for pick up.
Applicant Signature:
Date:_______________
Required signature indicates agreement with the above criteria.
FOR COUNTY STAFF USE ONLY BELOW THIS LINE
Date Received:
Fee Paid:
Receipt#:
Initials:________Letter:_________
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