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DOUGLAS COUNTY PLANNING, ZONING & LAND INFORMATION OFFICE 1313 BELKNAP STREET, ROOM 206, SUPERIOR, WI 54880 715 – 395-1380 / FAX 715 – 395-7643 Douglas County Fire Number Application Rev. 05/2022 ADDRESS (FIRE NUMBER) APPLICATION COMPLETE SITE SKETCH ON REVERSE SIDE Property Owner’s Name: Mailing Address: City, State, Zip: Daytime Telephone: E-mail Address: PROPERTY DESCRIPTION: Information must be complete and accurate. If applicable state lot number, block number, subdivision name, government lot number, quarter sections, etc. (Note: This may be copied from your tax notice or deed.) Tax Parcel Section: Town: N Range: W Town / Village of: Parcel Acreage or Size: Legal Description: Name of Road: Will This Be Your Permanent Mailing Address: Yes No COMPLETE SITE SKETCH ON REVERSE SIDE Signature of Property Owner: Date: Printed Property Owner Name: Date: This Application Is For: New Address Assignment Revised Address Replacement Sign County Use Only – Do Not Fill Out Anything Below This Line New Assigned Address Number: E / S GPS Coordinates for Driveway: City: Zip Code: Date Approved by Mapping: Approved By: G. Leppink D. Martin R. Schaffer Z. DeVoe Cost: Receipt Permit Number: Date Paid: Vendor Date Issued: ---PAGE BREAK--- BELOW PROVIDE A DIAGRAM INDICATING THE LOCATION OF YOUR DRIVEWAY AND SHOW THE NEAREST RURAL ADDRESS NUMBERS IN RELATION TO IT. FIRE NUMBER ON THE LEFT OF YOUR FIRE NUMBER ON THE RIGHT OF YOUR If applying by mail, please complete application and return with following fee: - $150.00 without attached Land-Use application. - $50.00 with attached Land-Use application. Douglas County Zoning Office 1313 Belknap Street, Room 206 - Superior, WI 54880