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Jefferson County E-911 NEW ADDRESS APPLICATION Full Name Current Mailing Address City, State, Zip Current Phone# Home Work Best Time to Contact Name of road new structure will be addressed on NOTE: If located on a corner, list road which driveway will access Name of subdivision or landowner Lot# Type of structure to be addressed: Please check type below House Mobile Home Travel Trailer Business Other Number: Can your new structure be seen from the road? Yes No Will your new structure share a driveway with another structure? Yes No If yes, what is the existing structure’s 911 address? Special notice or directions Please be advised it may take 3-5 business days to receive an address. A confirmation letter will be sent to your email DO NOT WRITE BELOW HERE PRESENT MAILING ADDRESS (Please print clearly) NEW ADDRESS INFORMATION New 911 Address: Complete this form and return to: Jefferson County E-911 P.O. Box 658 911 Clarks Mill Road Louisville Georgia 30434 Email: [EMAIL REDACTED]