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C r <br /> Cr 0 A. <br /> a <br /> SHORT-TERM RENTAL LICENSE APPLICATION-Burnett County, WI 1 <br /> Applicant Complete All Sections Below This Lined <br /> cr <br /> Original License Fee=,.$309i Renewal License Fee (Annually) = $150 V <br /> Property Owner's Name: R.Q\(� �i Ck.. r yU, C(1 <br /> Property Owner's Mailing Address: \UC\ v M(N N.1/ V\ U 6C'"n 1,0y S1-101 6 < �`' <br /> ���CCC ~ <br /> II 11 A. <br /> City State Zip ' <br /> Property Site Address: l� 6 i'�� �� Q \C(� �ebS t�� �Z Sk �3 <br /> Applicant's Telephone Number: f) I C S 1 Li it `° <br /> k <br /> Applicant's Email: A k S 0. _ccf SU��� l\�I j 31\Cl t \ , i rD <br /> DescriptionProperty: \Uk )\ CS(Y\ V \ P u1�, 4 DiA\a* \ C Sm V 5 P \S b Jin(ADO\Di- d --- <br /> Legal <br /> of Pro e , , <br /> Section#: 2-5-- <br /> Town#: 3? N Range#: /( W Town of: AleseM 0,1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ago 4' <br /> d q C c <br /> Tax ID#(1-5 digit number;found on tax statement):_ I l g g se.kii 0v. ,) umC( �;L&j l 4. C N , ' <br /> wk. 1J5� pUtchast y.IN prop to <br /> Provide Rental Information J <br /> License Year Applied For: aha\ Amount of Renters Applied For: C7 _ P I <br /> `\ <br /> b . <br /> Local Contact's Name: \ 1(\ to`(c,\,)SC' a,, <br /> _____ <br /> r <br /> Local Contact's Address: <br /> 6 N 0 C f y Stct 1 I(10»i\--u n (Z o SpoMei S H KO I ••N f <br /> IA _ City State Zip <br /> Local Contact's Telephone Number: I I > J -O `1 0 C> <br /> Most Recent Burnett County License Number: STR- <br /> State ice se umber: t'C ir' _-P. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLYH o <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 7lii'5 per i/ expire-5 o% 1/31/240 2.2- • oQ <br /> Obote P / P P <br /> C;�o g v c c u at K T'S U I N y eviA►, 4z <br /> S fiv— 2t - 7cf, / e <br /> O 0rtrite_way wecii-1 iv !Mt-e7 S/ if be-re G�Ioy 'er' g <br /> 1)'oeNKSe- PO b e- is S U a . , <br /> dFee Rec:340 <br /> CK4 !03 <br /> Date of staff site visit: lig/ZeL/ Initials of site visit staff: j7. < = �� <br /> LICENSE APPROVED BY : - DATE: ZZ �Z/ 1�.,1 <br /> LAND SERVICES OFFICIAL as D. u(u�u <br /> o (FE(FEn( ti <br /> I§ <br /> � o <br /> Page 1 of 3 i'4 ^...2 <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2020 4, <br /> n <br />