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Address Assignment Request

ALLEGAN COUNTY HEALTH DEPARTMENT
3255 - 122nd Ave., Suite 200, Allegan, MI 49010
Environmental Health Division
Phone: (269) 673-5415 / Fax: (269) 673-4172
Email: AlleganEH@allegancounty.org

1. Applicant Information

First Name

Last Name

Current Mailing Street Address

City

Zip

Email Address This question requires a valid email address.

Home Phone or Cell

2. Addresses on BOTH sides and ACROSS the street from property (when facing the house/property from the road)

Address LEFT side

Address RIGHT side

Address ACROSS the street

3. Distance from property lines (left and right when facing house/property) to proposed home

4. Direction home faces/will face

5. Municipal Water

6. Municipal Sewer

7. Has a soil boring been completed on the parcel?

8. Property Location Information

Tax/Parcel ID

Township *This question is required.

Subdivision (if applicable)

Lot #

Section #

9. Reason for Address (please check all that apply):

New Home (single family residence)
Duplex
New Home (multi family dwelling)
Commercial

Non-habitable structure (i.e. pole barn, irrigation well, etc.)
Clarification of house number
Correction of previous house number
No previous number has been assigned

PROPERTY DRAWING

NOTE: You can search for the property, then print or save the image for your drawing background from the Allegan County Parcel Viewer.

Please submit a drawing that contains the following:

All property lines
Location of structures
Addresses next to and across from property

10. Upload a Property Drawing (click browse to locate the file on your device) - maximum file size 25MB allowed

File: {{filename}} delete

---------------------FOR OFFICE USE ONLY---------------------

Assigned Address:

Sanitarian Name:

Date: