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ADDRESS NUMBER APPLICATION DATE FILED PROPERTY OWNER CURRENT MAILING ADDRESS CITY STATE ZIP CODE TOWN OR VILLAGE NAME OF ROAD LEGAL DESCRIPTON SECTION TOWNSHIP RANGE TAX PARCEL NUMBER WILL THIS BE YOUR PERMANENT MAILING ADDRESS? *********PLEASE CONTINUE ON REVERSE SIDE OF APPLICATION********* FOR COUNTY USE ONLY NEW ASSIGNED ADDRESS NUMBER: COST: $50.00 RECEIPT NUMBER: DATE PAID: VENDOR NUMBER: COPIES: EMERGENCY MANAGEMENT TOWN/VILLAGE CLERK TAX LISTER MAPPING PHONE: HOME: WORK: DATE APPROVED BY MAPPING: Print Form ---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 PROPERTY: FIRE NUMBER ON THE RIGHT OF YOUR PROPERTY: RETURN APPLICATION ALONG WITH THE $50.00 FEE TO: DOUGLAS COUNTY ZONING OFFICE 1313 BELKNAP STREET, ROOM 206 SUPERIOR, WI 54880 Revised Effective 7/2010 ±