New Address Request

New Address Request
Application Date*

MonthDayYear
Property Owner Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Where - Please enter the name of the road that the driveway will connect to:*

Road/Street Name

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide an Aerial Map screenshot (from Google Maps) and be sure to show the following:
- Location of the property in conjunction to an existing road
- Location of the driveway on the property
- Location of residence/building on the property
In the event the provided information does not match the final result of construction, we reserve the right to change the address to keep the road in sequence with the other residents of the road.
Aerial Map Upload*

Cancelof
New Road Name
Please provide a road name ONLY if one or more property owners will be accessing the same driveway.
The Lawrence County Emergency Communications Board advises the property owner shall bear its own costs and expenses in connection with this change of address or assignment of address. The property owner shall indemnify and hold the Lawrence County Emergency Communications District harmless from any claim (together with the costs and expenses incurred in connection with such claims) for costs or expenses incurred by the property owner in connection with this change of address or assignment of address. The Lawrence County Emergency Communications Board specifically and unconditionally disclaims any obligations for such costs which solely and exclusively by the property owner.
Should be Empty: