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En e r <br /> 0 n <br /> g ft <br /> SHORT-TERM RENTAL LICENSE APPLICATION– Burnett County, WI <br /> s c <br /> Applicant Complete All Sections Below This Line o <br /> cr <br /> Original License Fee = $300 Renewal License Fee(Annually) =$150 �, <br /> Property Owner's Name: Q L+' / - 4'Ar ;// a N CA <br /> Property Owner's Mailing Address: „2.5/e) /`,t�(f'i 1Z r'f d�< ' j'e '�' y` Np �✓ ty Sta e Zip r {� <br /> Property Site Address:16 519 ,. let?o i' /a%C'�`'/el ,7i'�1� il by 6236,3- o t 0 <br /> 5/1""1"Y- �e 0 <br /> Applicant's Telephone Number: / 9 537 7)' p <br /> Applicant's Email: , ( N, '/ 6...,) , -e, ,/ze/yr` T -, <br /> Pry <br /> o § 'U <br /> Legal Description of Property: Loo. 1 GSM V 17 f'151 ( 3Z8237) (Gov L #3) (W/t~SMT-433006) P <br /> c <br /> Section#:&,3 <br /> Town#;`5 9 N Range#: /17 W Town of: ,eLff 4 additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ao I� `' p <br /> , t .?":- <br /> Tax ID#(1-5 digit number;found on tax statement): /,2, Q / c i <br /> 0 <br /> Provide Rental Information <br /> License Year Applied For: 2 C/ z Z Amount of Renters Applied For: i $ <br /> 0 <br /> Local Contact's Name: y%y�z,) /42,/e/;"3-4',/"%- °4 <br /> /1/ 174)23 /Pae y J' / �- i z <br /> Local Contact's Address: C� / C ✓�' � _ v.-) <br /> �/f_ City State Zip pp <br /> Local Contact's Telephone Number: 7/,5 ,] S 7 l / o <br /> Most Recent Burnett County License Number: STR- State License Number:N t P.H -8S G P qqs -s <br /> W X <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: • °g ON <br /> sock i- 6haisn on Se, ►c )-c4./-1 k- +ho.n h ole.. uoiin o <br /> /y1aX, mum umoon'S oe ccnrer5 % , q ea?le., Inclvd(n_ ch',ldceii. v, v <br /> z T` <br /> t'A\ovv a.11 \cense e u►ceMcnts. z <br /> L'' Cens - C %c-e4 1 - 3123 is <br /> `,..Y2 � <br /> Fee Rec: 9 <br /> z <br /> Cie-4 /.279 <br /> v <br /> 01 <br /> m <br /> Date of staff site visit: 2- "'i. -Z i Initials of site visit staff: K L < <br /> F) <br /> m <br /> rn <br /> LICENSE APPROVED BY : A/.12140-' 4.1X DATE: Z -2 -2 Z <br /> LAND SERVICES OFFICIAL uuu <br /> y _O <br /> Pagelof3 . iiiii <br /> S3 v 4 <br /> Burnett County, WI Short-Term Rental License Application—Rev 12/2020 <br /> z % �� <br /> a <br /> m <br />