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2. 
3. Wyoming County Highway Department

        4328 State Route 19, Silver Springs, NY 14550

        Phone (585)786-8955        Fax (585)786-3297

                      Devin Blue - Superintendent

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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