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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. 08/2014 ADDRESS (FIRE NUMBER) APPLICATION REMEMBER TO 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 Please complete site sketch on reverse side of application Signature of property owner: County Use Only – Do Not Fill Out Anything Below This Line This Application Is For: New Address Assignment Revised Address Replacement Sign New Assigned Address Number: E / S GPS Coordinates for Driveway: City: Zip Code: Date Approved by Mapping: Approved By: R. Jones D. Martin Cost: Receipt Permit Number: Date Paid: Vendor Date Issued: cc: Emergency Mgmt. Property Lister Township Land Records / GIS ---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, along with $50.00 fee to: Douglas County Zoning Office 1313 Belknap Street, Room 206 Superior, WI 54880