Form List

Information gathered is used to help emergency service personnel respond to 911 calls.  This form must be completed for all habitable structures in Johnson County.  Please note that the naming of a road or assignment/re-assignment of an address is a ministerial act.  Johnson County, its employees or agents, do not warrant or assure that any road or easement is public or private nor what parties or landowners have a right to use said easement. Most address requests are completed within 1-2 business days, however, addresses will not be issued until all permit dues are met.

After receiving notification of address, please post it on your mailbox using 3” reflective numbers  and  home or gate, using 4” reflective numbers to aid in emergency response. If your residence is not close to your mailbox, it is imperative that the entrance to your property AND your structure be marked with your address number.  Address must be visible from both sides of the road.

1

First and Last Name of Individual Making the 9-1-1 Address Request.

 *

First and Last Name of Individual Making the 9-1-1 Address Request.

2

Phone Number

 *

Phone Number

3

E-mail address (if applicable). Completed form will be sent to this E-mail address only. Otherwise, completed form must be picked up in person.

E-mail address (if applicable). Completed form will be sent to this E-mail address only. Otherwise, completed form must be picked up in person.

4

Applicant's Mailing Address

 *

Applicant's Mailing Address

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5

Johnson County Central Appraisal District ID of the Property Needing an Address. This ID starts with "126." and can be obtained from the Johnson County Central Appraisal District.

 *

Johnson County Central Appraisal District ID of the Property Needing an Address. This ID starts with "126." and can be obtained from the Johnson County Central Appraisal District.

6

Nature of Request:

Nature of Request:

New construction of residential or commercial property

Need verification of existing address

Utilities Only (cannot be used for a structure)

Other (Please mention under general plans for development)

7

Will this newly requested address be the primary address on the property?

Will this newly requested address be the primary address on the property?

Yes, this address will be the primary address on the property.

No, this address will not be the primary address on the property.

8

Please describe the general plans for development on this property:

 *

Please describe the general plans for development on this property:

9

Description of Structure:

Description of Structure:

Mobile/Manufactured Home

Single Family Residence

Condo/Townhouse/Apartment

Commercial

Barn/Shed/Shop

Not Applicable

10

Expected Time of Construction:

Expected Time of Construction:

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11

Are you a livestock owner who would like to participate in our loose livestock location map? This is a private map only seen by deputies and dispatchers that is free-of-charge and helps us find owners of loose livestock.

Are you a livestock owner who would like to participate in our loose livestock location map? This is a private map only seen by deputies and dispatchers that is free-of-charge and helps us find owners of loose livestock.

Yes, I would like to participate in the loose livestock map.

No, I am not a livestock owner or I would not like to participate.

12

If you selected yes, please thoroughly describe the animal species, brand or any other information you can provide:

If you selected yes, please thoroughly describe the animal species, brand or any other information you can provide:

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13

By checking this box, the applicant/property owner agrees to obtain all applicable permits from Johnson County Public Works before any construction begins.

 *

I, the applicant or property owner, agree to obtain all permits necessary prior to any construction on this property. If other, type text here.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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