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House Number Request Form

2. 

3. Wyoming County Highway Department
   4328 State Route 19, Silver Springs, NY 14550<BR>Todd Gadd - Superintendent of Highway<BR>Phone (585)786-8955<BR>Fax (585)786-3297

   4328 State Route 19, Silver Springs, NY 14550
   Todd Gadd - Superintendent of Highway
   Phone (585)786-8955
   Fax (585)786-3297

5. 1. Date of Application*
   1. Date of Application

6. 2. Town of*
   -- Select One --ArcadeAtticaBenningtonCastileCovingtonEagleGainesvilleGenesee FallsJavaMiddleburyOrangevillePerryPikeSheldonWarsawWethersfield

8. 3. Road on which house number is applied for*

10. 4. Name of Applicant*

11. 5. Former Owner (if new purchase)

13. 6. Parcel ID (Parcel ID is located on either your deed or tax bill)*

15. 7. Telephone number*

17. 8. Between what intersections is house/property located*

19. 9a. Nearest cross road

20. 9b. Which side of road

    1. North
    2. South

    1. East
    2. West

22. 10a. Neighbors: on same side

23. 10b. House number, if known

25. 10c. Neighbors on opposite side

26. 10d. House number, if known

28. 11. Purpose for new number*
    -- Select One --New houseUtilitiesOther

29. Proposed driveway location is staked or marked?*

    1. yes

    1. no

    Proposed driveway location must be staked or marked. Please allow a minimum of two (2) weeks for information to be checked and approved.

31. 12. Current Mailing Address*

33. City*

34. State*

35. Zip Code*

37. Email Address

Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

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