Licenses & Fees Committee (Meets as needed, often on the 3rd Monday of the month at 3:30 p.m.)
Regular MeetingSuperior, WI · November 8, 2021
Minutes
License and Fees Committee Meeting Agenda
City of Superior, Wisconsin
The meeting was called to order by Vice President Fennessey at 1:02 pm on November 8, 2021 in Government
Center Room 204.
1. Roll Call
COUNCILORS PRESENT: Brent Fennessey, Jack Sweeney & Lindsey Graskey (Alt)
COUNCILORS PRESENT: Craig Sutherland
CITY STAFF PRESENT: City Clerk Ramos
2. Approval of minutes from 10/20/2021 committee meeting.
MOTION by Councilor Graskey to approve, seconded by Councilor Sweeney and
carried.
3. City Clerk Ramos is recommending the approval of an Outdoor Alcohol Consumption
License application for JamRock Cultural Restaurant, LLC (Agent: Antonio O’Neil),
located at 1901 Tower Avenue, for the 2021-2022 license period, expiring June 30, 2022.
MOTION by Councilor Sweeney to approve, seconded by Councilor Graskey and
carried.
4. Review of the following City of Superior license applications (and their current fees):
1. Tavern Operator
MOTION by Councilor Sweeney to increase annual license fee from $15/year to
$20/year, seconded by Councilor Graskey and carried.
2. Taxicab Operator
MOTION by Councilor Graskey to postpone action on this item and
corresponding item no. 6 (Vehicle for Hire) until December committee meeting,
seconded by Councilor Sweeney and carried.
3. Massage Therapy Business
MOTION by Councilor Graskey to postpone action on this item and
corresponding item no. 4 (Massage Therapy Practitioner) until December
committee meeting, seconded by Councilor Sweeney and carried.
Licenses & Fees Committee Meeting, 11/8/2021 Page 1 of 2
4. Massage Therapy Practitioner
Application considered in conjunction with Item 3.
5. Animal-Drawn Vehicle For Hire
MOTION by Councilor Graskey to continue using the license application as is in
going forward, seconded by Councilor Sweeney and carried.
6. Vehicle For Hire (Taxicabs/Limos)
Application considered in conjunction with Item 2.
7. Manufactured Home Park (formerly called Mobile Home Court)
MOTION by Councilor Fennessey to update application to clearly set $100
maximum application fee for 50 units, seconded by Councilor Graskey and
carried.
The committee requested more time to review the recommended application
updates, which the City Clerk’s Office supplied as handouts—attached.
Councilor Sweeney requested that the committee submit all application fee
increases to council for approval simultaneously.
Councilor Fennessey requested that the update to the Manufactured Home Park
application also be rescinded and submitted to council at a later date, with the
approved application fee increases.
MOTION by Councilor Graskey, to rescind and hold all approved agenda item 4
motions as internal recommendations so that all application updates can be
submitted to Council for approval simultaneously, was seconded by Councilor
Sweeney and carried.
5. Adjournment
Meeting was adjourned 2:23 pm.
Respectfully submitted,
Camila Ramos, City Clerk
Superior, Wisconsin
.
Licenses & Fees Committee Meeting, 11/8/2021 Page 2 of 2
Agenda
License and Fees Committee Meeting Agenda
City of Superior, Wisconsin
November 8, 2021– Gov’t Center Room 204 – 1:00 p.m.
Members: Brent Fennessey, Jack Sweeney, Craig Sutherland & Lindsey Graskey (Alternate)
1. Roll Call
2. Approval of minutes from 10/20/2021 committee meeting.
3. City Clerk Ramos is recommending the approval of an Outdoor Alcohol Consumption
License application for JamRock Cultural Restaurant, LLC (Agent: Antonio O’Neil),
located at 1901 Tower Avenue, for the 2021-2022 license period, expiring June 30, 2022.
4. Review of the following City of Superior license applications (and their current fees):
1. Tavern Operator
2. Taxicab Operator
3. Massage Therapy Business
4. Massage Therapy Practitioner
5. Animal-Drawn Vehicle For Hire
6. Vehicle For Hire (Taxicabs/Limos)
7. Manufactured Home Park (formerly called Mobile Home Court)
5. Adjournment
Notice is hereby given that a majority of the members of the Common Council may be present
at the meeting, and although this may constitute a quorum of the Common Council, the
Council will not take any action at this meeting.
******************************************************************************************************************************************************
Pursuant to the Americans with Disabilities Act of 1990, if you are in need of an accommodation to participate
in the public meeting process, please contact Nick Raverty at (715) 395-7212 by 4:30 p.m. on the day prior to the
scheduled meeting date (OR dial 711 for Telecommunications Relay Service). The City will attempt to
accommodate any request depending on the amount of notice received.
******************************************************************************************************************************************************
In compliance with Wisconsin Open Meetings Law, this agenda was posted on 11/5/2021 at the following locations:
Superior Government Center, Douglas County Courthouse, and online at https://www.ci.superior.wi.us/agendacenter. It was also
emailed to the Superior Public Library (to be posted) and to the Superior Telegram.
Licenses & Fees Committee Meeting, 11/8/2021 Page 1 of 1
License and Fees Committee Meeting Proceedings
City of Superior, Wisconsin
The meeting was called to order by Clerk Ramos at 2:01 pm on October 20, 2021 in Government Center
Room 204.
1. Roll Call
COUNCILORS PRESENT: Brent Fennessey, Jack Sweeney, Craig Sutherland &
Lindsey Graskey (Alternate)
CITY STAFF PRESENT: City Clerk Ramos, Chief of Staff Raverty, City Attorney
Prell
2. Selection of Committee President and Vice President.
Motion by Councilor Sweeney, seconded by Fennessey and carried by unanimous
voice vote, to elect Councilor Sutherland as Committee President.
Motion by Councilor Sweeney, seconded by Sutherland and carried by unanimous
voice vote, to elect Councilor Fennessey as Committee Vice President.
3. Review of committee mission statement and regular meeting schedule.
No action taken by the committee members who agreed to convene each month, if
necessary, as scheduled in the Boards, Commissions & Committees Directory.
4. City Clerk Ramos is recommending the approval of an Outdoor Alcohol Consumption
License application for JamRock Cultural Restaurant, LLC (Agent: Antonio O’Neil),
located at 1901 Tower Avenue, for the 2021-2022 license period, expiring June 30, 2022.
City Attorney Prell reported that both the Police and Fire Departments are
recommending the committee postpone making a decision on whether to issue the
supplemental liquor licenses to JamRock due to ongoing investigations.
Motion by Councilor Sweeney, seconded by Councilor Sutherland and carried, to
allow Police Department & Fire Department a month to complete their
investigations and report back to the committee.
5. City Clerk Ramos is recommending the implementation of late fee schedule for
renewable licenses issued by the City Clerk’s Office.
Motion by Councilor Sweeney, seconded by Councilor Fennessey and carried, to
implement a late fee, which equals 50% of the total application fee, for all annual
miscellaneous licenses maintained by the clerk’s office.
Licenses & Fees Committee Meeting, 10/20/2021 Page 1 of 2
Motion by Councilor Fennessey, seconded by Councilor Sweeney and carried, to
allow licensees a grace period of 5 business days to submit their renewal paperwork
and avoid an additional late fee.
Motion by Councilor Fennessey, seconded by Councilor Sweeney and carried, to set
a minimum late fee of $25.
Motion by Councilor Fennessey, seconded by Councilor Sweeney and carried, to
establish an additional fee, equal to 50% of the total application fee, to reinstate a
license after 15 business days.
Councilor Fennessey left the meeting after this vote.
6. Review of Licenses issued by the City Clerk’s Office, and their applications.
The City Clerk’s Office will be updating license applications to include all the city
code and state statute requirements and supplying them to the committee for review
at future committee meeting(s).
No action taken.
7. Brainstorming for future meeting topics.
Ccommittee members requested that the clerk check in with Assistant Finance
Director Deb Kamunen, who has been reviewing fees for licenses maintained by
the city.
No action taken.
8. Adjournment
Meeting was adjourned 3:28 pm.
Respectfully submitted,
Camila Ramos, City Clerk
Superior, Wisconsin
Licenses & Fees Committee Meeting, 10/20/2021 Page 2 of 2
Ramos, Camila
From: Gordon, Scott
Sent: Friday, November 5, 2021 9:05 AM
To: Ramos, Camila
Cc: Prell, Frog; Alexander, Nicholas F.
Subject: FW: Approval Request: Cabaret and OAC License Apps (JamRock Cultural Restaurant)
Attachments: Cabaret_JamRock.pdf; OAC_JamRock.pdf
Camila: we have met with the owner of JamRock and have come to an agreement. We are OK with both of these
applications.
Scott Gordon
Fire Chief, Superior Fire Department
3326 Tower Av, Superior WI 54880
715‐395‐1680
715‐395‐1644 direct
From: Ramos, Camila <ramosc@ci.superior.wi.us>
Sent: Monday, October 25, 2021 11:53 AM
To: Sertich, Daniel <sertichd@ci.superior.wi.us>; Cardenas, Brandon <cardenasb@ci.superior.wi.us>
Cc: Harker, Angie <harkera@ci.superior.wi.us>; Gordon, Scott <gordons@ci.superior.wi.us>
Subject: Approval Request: Cabaret and OAC License Apps (JamRock Cultural Restaurant)
Hi, all,
Please see attached and advise of approval or otherwise at your earliest convenience.
Thanks,
Camila
Camila Ramos
Superior City Clerk’s Office
Phone: 715-395-7200
Website: www.ci.superior.wi.us
1
CITY OF SUPERIOR
Tavern Operator License Application
FEE: $30.00
NEW - Present Photo ID & a copy of your certificate from a Bartender’s Training Course approved by the
State of Wisconsin to clerk with application.
If course has not been completed, complete the provisional portion of this application on back of form.
RENEWAL - Present Photo ID & previous license to clerk with application.
Renewals may be submitted by mail with application fee (payable to City Treasurer), and copies of your current tavern
operator license and valid state-issued photo ID.
**** PLEASE PRINT CLEARLY****
Last Name First Name Middle Name
Previous Name(s) Employer (Where you will be using this license)
Date of Birth Phone Number Email Address
Home Address City State Zip
Mailing Address (if different than home address) City State Zip
Previous Home Address (if less than 2 years at current address) City State Zip
Have you ever been convicted of a felony? YES – Details required on page 2 . NO
Are there any criminal charges presently pending against you? YES – Details required on page 2 . NO
Please be advised that the Police Department will review and verify the information on your application. If any information is
omitted, incomplete or incorrect, the Police Department may deny your license application. Other reasons for denial may include a
felony conviction or if you have been a habitual law offender as defined in Wisconsin State Statutes 125.04(5)(b). If your application
is denied for any reason, your license fee will not be refunded.
BY SIGNING BELOW, I ACCEPT THIS LICENSE, SUBJECT TO REVOCATION BY THE COUNCIL OF THE CITY
OF SUPERIOR, UPON CONVICTION OF ANY OF THE PROVISIONS OF THE ALCOHOL LICENSE ORDINANCE.
(City Code – Chapter 14 & Wisconsin State Statues 125.17)
_________________________________________ _____________________________
Signature Date
FOR OFFICE USE ONLY
2 YEAR LICENSE PERIOD: JULY 1, 20____ THROUGH JUNE 30, 20____ Previous License No. _______________
Receipt No. __________ Receipt Date_____________ License No.______________
Background Check: Approved Denied __________________________________________ Date______________
Police Chief Signature
Issued YES NO If yes, date Issued __________________________________________________________
City Code Chapter 14; Wisconsin State Statue 125.17
Form Updated 2021
City Clerk’s Office • 1316 N. 14th St. Room 200 • Superior, WI 54880 • (715) 395-7200
PROVISIONAL (60-DAY) LICENSE (FEE $5.00): A provisional license may be granted if you have applied
for an Operator’s License & are enrolled in the responsible beverage server training course as required by WI
Statutes 125.17(5). License may be revoked if any falsification has been made on this application. License is
valid for a period not to exceed 60 days or until a regular license is issued.
_________________________________ _______________ ______________to___________ (60 days)
Signature Date of Course License Period
LIST ALL PAST VIOLATIONS
Date____/____/____ Nature of Offense_________________________________________________
Date____/____/____ Nature of Offense_________________________________________________
Date____/____/____ Nature of Offense_________________________________________________
Date____/____/____ Nature of Offense_________________________________________________
Date____/____/____ Nature of Offense_________________________________________________
Date____/____/____ Nature of Offense_________________________________________________
PENDING CHARGES
Date____/____/____ Nature of Charge _________________________________________________
Date____/____/____ Nature of Charge _________________________________________________
Date____/____/____ Nature of Charge _________________________________________________
Date____/____/____ Nature of Charge _________________________________________________
CITY OF SUPERIOR
Taxicab Operator License Application
Application Fee: $25
NEW RENEWAL – Previous License No. _____________________________________________________________
Last Name First Name Middle Name
Phone Number Email Address
Date of Birth Place of Birth Race Height Hair color Eye color
Home Address City State Zip
Mailing Address (if different from above) City State Zip
Previous Address (if less than 3 years at current address) City State Zip
Employer (Name of Taxicab Company) Place of previous employment
Valid Regular Driver’s License number Issuing State Expiration Date
Has your driver’s license ever been suspended or revoked? YES NO
Is your license currently subject to pending charges? YES NO
Have you ever been convicted of a felony? YES NO
Are there any criminal charges presently pending against you? YES NO
**If yes to any, list circumstances and date(s) on the back of this application.
By signing below, I understand that the Police Department will review and verify the information on my application through a
background check. I accept that my license is subject to revocation at any time for a violation of any of the provisions of City
Ordinances regulating my business (City Code – Chapter 112, Article VI, Division 4 beginning at 112-331); I also accept that my
application fee will not be refunded if my application is denied for any reason.
Application must be sworn to and signed before Clerk or other Notary Public.
_____________________________________________________ ____________________________
Applicant Signature Date A copy of your
Subscribed & Sworn to before me on this____day of __________ , 20____. driver’s license
& a current
Apply passport photo
Seal Notary Public Signature _________________________________________ IS REQUIRED
Here Printed Name _________________________________________ with application.
Date Commission Ends __________________________________________
FOR OFFICE USE ONLY
Annual License Period: July 1, 20___ through June 30, 20___ License No. __________________________________
Total Paid ___________ Receipt No. ___________ CC Mtg Date ___________ Date Sent to PD _________________
Background Check: Approved Denied – State reason: ______________________________________________
Police Dept Signature __________________________________________________ Date Issued __________________
Reference: City Code 112-311
Form Updated 2021
Remit to CITY CLERK’S OFFICE with application fee made payable to City Treasurer.
1316 N. 14th St. Room 200 • Superior, WI 54880 • (715) 395-7200
List all past license suspensions/revocations:
Date____/____/____ Circumstances____________________________________________________________
Date____/____/____ Circumstances____________________________________________________________
Date____/____/____ Circumstances____________________________________________________________
Pending charges on license:
Date____/____/____ Circumstances____________________________________________________________
Date____/____/____ Circumstances____________________________________________________________
Date____/____/____ Circumstances____________________________________________________________
List all past felony convictions:
Date____/____/____ Circumstances____________________________________________________________
Date____/____/____ Circumstances____________________________________________________________
Date____/____/____ Circumstances____________________________________________________________
Pending criminal charges:
Date____/____/____ Circumstances____________________________________________________________
Date____/____/____ Circumstances____________________________________________________________
Date____/____/____ Circumstances____________________________________________________________
CITY OF SUPERIOR
Massage Therapy Business License Application
Application Fee: $50
Business Name Business Phone Number
Physical Address City State Zip
Mailing Address Same As Physical Address City State Zip
Description of premises
Owner Name Previous Name
Date of Birth Phone Number Email Address
Home Address City State Zip
Mailing Address (if different than home address) City State Zip
Previous Home Address (if less than 2 years at current address) City State Zip
Second Owner/Manager/Operator Name (if different from above) Previous Name
Date of Birth Phone Number Email Address
Home Address City State Zip
Mailing Address (if different than home address) City State Zip
Previous Home Address (if less than 2 years at current address) City State Zip
Have any individuals ever been convicted of a crime/offense other than a traffic offense? YES (Details on back) NO
By signing below, I accept that my license is subject to revocation by the Common Council of the City of Superior—upon conviction of
any of the provisions of City Ordinances regulating my business (City Code – Chapter 74, Article V, beginning at 75-127) —and that my
application fee will not be refunded if my application is denied for any reason.
________________________________________________________ ________________________________
Signature Date
FOR OFFICE USE ONLY
Annual License Period: July 1, 20___ through June 30, 20___ License No. _________________________
Total Paid __________ Receipt No. _________ CC Mtg Date __________ Date Issued _________________
Police Chief Approval _________________________________________ Date ______________________
(See inspectors form.)
Fire Inspector Approval ________________________________________ Date _______________________
Form Updated 2021 Reference: City Code, Sec. 74-127
Remit to CITY CLERK’S OFFICE with application fee made payable to City Treasurer.
1316 N. 14th St. Room 200 • Superior, WI 54880 • (715) 395-7200
Name: _______________________________________________
LIST ALL PAST CONVICTIONS
Date____/____/____ Nature of Offense_________________________________________________
Date____/____/____ Nature of Offense_________________________________________________
Date____/____/____ Nature of Offense_________________________________________________
Name: _______________________________________________
LIST ALL PAST CONVICTIONS
Date____/____/____ Nature of Offense_________________________________________________
Date____/____/____ Nature of Offense_________________________________________________
Date____/____/____ Nature of Offense_________________________________________________
Name: _______________________________________________
LIST ALL PAST CONVICTIONS
Date____/____/____ Nature of Offense_________________________________________________
Date____/____/____ Nature of Offense_________________________________________________
Date____/____/____ Nature of Offense_________________________________________________
Name: _______________________________________________
LIST ALL PAST CONVICTIONS
Date____/____/____ Nature of Offense_________________________________________________
Date____/____/____ Nature of Offense_________________________________________________
Date____/____/____ Nature of Offense_________________________________________________
CITY OF SUPERIOR
Massage Therapy Practitioner License Application
Application Fee: $20
NEW – Applicant must have completed a course of study in massage therapy of not less than 500
hours from a recognized school where theory, method, profession and work of massage therapy is
taught. Applicant shall submit a diploma, certificate, or other written proof of education with
application, including the name and address of school.
RENEWAL – Present proof of previous licensing within the city.
**** PLEASE PRINT CLEARLY****
Last Name First Name Middle Name
Previous Name(s) Employer (Where you will be using this license if applicable)
Date of Birth Phone Number Email Address
Home Address City State Zip
Mailing Address (if different than home address) City State Zip
Previous Home Address (if less than 1 year at current address) City State Zip
Have you ever been convicted of a crime/offense other than a traffic offense? YES NO
If yes, please list:
Date____/____/____ Nature of Offense __________________________________________________________
Date____/____/____ Nature of Offense __________________________________________________________
Date____/____/____ Nature of Offense __________________________________________________________
By signing below, I accept that my license is subject to revocation by the Common Council of the City of
Superior—upon conviction of any of the provisions of City Ordinances regulating my business
(City Code – Chapter 74, Article V, beginning at 75-127)—and that my application fee will not be refunded if
my application is denied for any reason.
________________________________________________________ ________________________________
Signature Date
FOR OFFICE USE ONLY
Annual License Period: July 1, 20___ through June 30, 20___ Previous License No. __________________
Total Paid __________ Receipt No. _________ CC Mtg Date __________ License No. _________________
Police Chief Approval: ___________________________________________ Date ____________________
Issued YES NO Date Issued _______________________________________________________
Reference: City Code, Sec. 74-127
Form Updated 2021
Remit to CITY CLERK’S OFFICE with application fee made payable to City Treasurer.
1316 N. 14th St. Room 200 • Superior, WI 54880 • (715) 395-7200
CITY OF SUPERIOR
Animal Drawn Vehicle for Hire License Application
FEE: $25.00
**** PLEASE PRINT CLEARLY****
Business Name Business Phone Number
Physical Address City State Zip
Mailing Address Same As Physical Address City State Zip
Owner Name(S) Owner Phone Number
Owner Address City State Zip
Owner Email
Type of Vehicles Number of Vehicles
City Areas To Be Utilized
Location Where Vehicles & Animals Will Be Loaded/Unloaded
Sanitary Provisions Lights And Safety Equipment
Operational Time Of Day Operational Months Of Year
Additional requirements:
A copy of your certificate of insurance showing general liability for bodily injury in the amount of at least
$100,000 per person and $300,000 per accident and property damage in the amount of $10,000 is attached.
The certificate of insurance must provide that the insurance company will endeavor to give the city clerk ten
days’ advance notice of the expiration or cancellation of the policy.
The Name and Address for each driver is listed on the back.
BY SIGNING BELOW, I ACCEPT THIS LICENSE, SUBJECT TO REVOCATION BY THE COUNCIL OF THE CITY
OF SUPERIOR, UPON CONVICTION OF ANY OF THE PROVISIONS OF THE VEHICLE FOR HIRE ORDINANCE
(City Code – Chapter 112, Article VI, Division 4, beginning at 112-331).
_______________________________________ ___________________________________ ___________
Signature Printed Name Date
FOR OFFICE USE ONLY
ANNUAL LICENSE PERIOD: JANUARY 1, 20___ through DECEMBER 30, 20___ Previous License No. ________
CC Mtg Date ____________ Receipt No. __________ Receipt Date_____________ License No. ___________________
Issued YES NO If yes, date Issued ___________________________________________________________
CC: Police Dept City Code – Chapter 112, Article VI, Division 4. Beginning at 112-331
Form updated 2021
City Clerk’s Office • 1316 N. 14th St. Room 200 • Superior, WI 54880 • (715) 395-7200
Driver’s Names and Addresses
Driver Name
Driver Address City State Zip
Driver Name
Driver Address City State Zip
Driver Name
Driver Address City State Zip
Driver Name
Driver Address City State Zip
Driver Name
Driver Address City State Zip
Driver Name
Driver Address City State Zip
Driver Name
Driver Address City State Zip
Driver Name
Driver Address City State Zip
CITY OF SUPERIOR
Vehicle For Hire License Application
Application Fee: $150 for first vehicle, $100 each additional (Vehicles added after January 1st = $50 each)
CHECK ONE: Class I Taxicab equipped with taximeter
Class II All other vehicles which charge for services on a time of use basis (not equipped with taximeters)
Corporate/Business Name Trade Name (DBA)
Business Email Address Business Phone Number
Physical Address City State Zip
Mailing Address (if different from above) City State Zip
Owner Name Phone Number
Address City State Zip
Adding ____ vehicle(s), fleet number(s) ________________ Removing ____ vehicle(s), fleet number(s)________________
TOTAL LICENSED VEHICLES: _____
CHECKLIST FOR ITEMS WHICH MUST BE SUBMITTED WITH THIS APPLICATION:
Vehicle information sheet (see attached form)
Copy/Proof of Valid Vehicle Registration
Certificate of Liability Insurance not less than $500,000 for property, $500,000 for bodily injury or death for one person,
and $500,000 for injuries or death to more than one person (w/City Clerk listed as certificate holder)
Certificate from ASE Certified Automobile Mechanic for each vehicle (see attached form)
Schedule of Fees (rates of fares)
By signing below, I accept that my license is subject to revocation by the Common Council of the City of Superior—upon
conviction of any of the provisions of City Ordinances regulating my business (City Code – Chapter 112, Article VI,
beginning at 112-271)—and that my application fee will not be refunded if my application is denied for any reason.
______________________________________________________________ ___________________________________
Signature Date
___________________________________________________________________________________________________________
Print Name
FOR OFFICE USE ONLY
License Number(s) Fleet Number(s) Decal Number(s)
Annual License Period: July 1, 20___ through June 30, 20___
Total Paid _______ Receipt No. _______ CC Mtg Date _______
Vehicle Inspection(s): Approved Denied
____________________________________________________
Traffic Sgt. Signature
Issued? YES NO If yes, date issued ______________ Reference: City Code Ch. 112-271, 112-291
Remit to CITY CLERK’S OFFICE with application fee made payable to City Treasurer.
1316 N. 14th St. Room 200 • Superior, WI 54880 • (715) 395-7200
Form Updated 2021
Page 1 of 3
CERTIFICATION OF AUTO MECHANIC
VEHICLES FOR HIRE LICENSE
This form must be completed by Auto Mechanic.
Name of business that inspection was completed for:
_____________________________________________________________________________
Vehicle Information:
Make & Model _________________________________________________ Year _________
VIN # ___________________________________________Plate # ______________________
I, __________________________________, of _____________________________________,
Printed Name of Auto Mechanic business name and address
certify that I am an ASE (Automotive Service Excellence) certified automobile mechanic in the
City of Superior, and that I have inspected the above vehicle on this __________ day of
_______________________, 20____, and the vehicle complies with all applicable
requirements of WI Statutes Chapter 347 and Chapter MVD, Wis. Administrative Code.
____________________________________________
Signature of auto mechanic
Page 2 of 3
VEHICLE INFORMATION SHEET
Fill in the information for every NEW fleet vehicle you are licensing for current licensing period.
Cab Co.
PASSENGER
FLEET PLATE
CAPACITY
NUMBER YEAR MAKE & MODEL NUMBER VIN Number (Not including driver)
Page 3 of 3
CITY OF SUPERIOR
Manufactured Home Park License Application
Application Fee: $50.00 + $2.00 for each mobile home space within the court (may be prorated)
+ $15.00 Health Inspection fee
Name of Manufactured Home Park No. of Units
Local Office Address (must be located within the Manufactured Home Park) City State Zip
Superior WI 54880
Local Office Mailing Address (if different from Local Office Address) City State Zip
Local Office Phone Local Office Email
Local Owner/Manager/Operator Name (must maintain office at Local Office Address)
Date of Birth Phone Number Email Address
Home Address City State Zip
Mailing Address (if different from Home Address) City State Zip
Please fill out the following portion if the Manufactured Home Park is owned or overseen by an entity other than the Local
Owner/Manager/Operator
Business Name Contact Person
Business Phone Number Business Email
Business Address City State Zip
Business Mailing Address (if different from Business Address) City State Zip
By signing below, I accept that my license is subject to revocation by the Common Council of the City of Superior—upon
conviction of any of the provisions of City Ordinances regulating my business (City Code – Chapter 78)—and that my application
fee will not be refunded if my application is denied for any reason.
________________________________________________________ ________________________________
Signature Date
__________________________________________________________________________________________
Print Name
FOR OFFICE USE ONLY
Annual License Period: July 1, 20___ through June 30, 20___ License No. _________________________
Building Inspector Approval _________________________________________________ Date _________________
Fire Inspector Approval _____________________________________________________ Date _________________
Police Chief Approval _______________________________________________________ Date _________________
Health Inspector Approval __________________________________________________ Date _________________
Total Paid __________ Receipt No. _________ CC Mtg Date __________ Date Issued _________________
Form Updated 2021 Reference: City Code, Chapter 78
Remit to CITY CLERK’S OFFICE with application fee made payable to City Treasurer.
1316 N. 14th St. Room 200 • Superior, WI 54880 • (715) 395-7200
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