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Licenses & Fees Committee (Meets as needed, often on the 3rd Monday of the month at 3:30 p.m.)

Regular Meeting

Superior, WI · November 8, 2021

AgendaMinutes

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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