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New Address Request Form


    Complete applications for new addresses will be reviewed, and an address confirmation letter will be provided to the applicant. Addresses may not be issued on the day of the application

  2. Required Information

    1. Completed Request Form

    2. Last Recorded Plat  mark location of structure/culvert on plat

    A copy of the last recorded plat can be requested from the Superior Court located at 700 N. Pine St. Springfield, GA. 31329

  3. Select*
  4. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  5. I need a new 911 address for:*
  6. Road name for 911 addresses will be based on the driveway location. Provide correct road name, as seen on road signs.

  7. Water Service*
  8. Waste Water Service*

    Tax Map & Parcel ______________________     Zoning District: _____________________ Total Acres: _____________________

    Frontage on County-maintained road?   Y  /  N   (private road, see below)

    Private Road Name:                                                                                                                                             Sign in place?  Y  /  N  

    # of lots currently accessing private road/easement:                                                                                                                               

    Proposed name of new private road:                                                                                                                                                       

    Location (beginning at / ending at)                                                                                                                                                          

    Reviewed by Planning & Zoning:       /      /       Initials:                              Reviewed by GIS:       /      /       Initials:                               

    Approved?    Y  /  N    If not, reason:                                                                                                                                                       

  10. Leave This Blank: