Contact Sheila Beauchemin @sbeachemin@myfairpoint.net
TOWN OF COLEBROOK
17 Bridge Street
Colebrook, NH 03576
(603) 237-4142
New Construction 911 Address Request Form
Applicant Information
Name: __________________________________________________
Address: _________________________________________________
Phone: __________________________________________________
Landowner Information
Name (if different from Applicant): ________________________________
Address: _________________________________________________
Phone: __________________________________________________
Street Location: ___________________________________________
Map/Lot: ________________________________________________
Please make a sketch showing the driveway location and measurements below. (Also, physically mark the location of your driveway with stakes and/or flagging so it may be easily located). An approved copy of your building permit must accompany this request.
You will receive notice of your 911 address when the State Bureau of Emergency Communication Mapping Division has completed the inspection and notified the Town Of Colebrook.
Applicant Signature _____________________________ Date ______
Landowner Signature ____________________________ Date ______
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For Town Use Only
Received by _________________________________ Date received ____________
Assigned # __________________________________ Date assigned ____________
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Notify: Applicant/Owner __________ Post Office __________ 911 system ________
Colebrook Police & Fire Departments _________ Verizon _________
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