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c <br /> a Fv' <br /> r t" <br /> ' <br /> SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI I: `° : <br /> y <br /> c <br /> Applicant Complete All Sections Below This Line a c <br /> S <br /> Original License Fee= $300 Renewal License Fee(Annually) = $150 v\.).1 A <br /> Property Owner's Name: SUSQ Y1 e ^\AC-9, P � r IYS �) y <br /> c� <br /> 20 <br /> Property Owner's Mailing Address: c,( 7 ci 0 (I',�k tern / oc P 1 coca r LUIS ° •� <br /> / City State Zip ' <br /> Property Site Address:,),—)1•0,--1, COarr-}1RocArlPk . Nc (...,-2,1 ,-, Sq S C j F. --- <br /> .,1al <br /> Applicant's Telephone Number: t G25 I) 4 gra—\1o.-24 r��n <br /> �o <br /> Applicant's Email: SC- r,n' 29 E5'(YIC�.k\‘ 0_� \ a <br /> fPecipr3c OS % S <br /> Legal Description of Property: \_...0+' a oC C.S i"1 i_49 L t vol d 1 p ani l Doc Likoval r <br /> Section#: Town#: ?Pi N Range#: i 4 W Town of: ► (SvJ ivy <br /> • <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* do n : <br /> Tax ID#(1-5 digit number;found on tax statement): 3s'ttii 35 L1 VA 5. c kJ G <br /> •Provide Rental Information ce( Q <br /> .� <br /> License Year Applied For: cD 0-(:) ,. Amount of Renters Applied For: —S--en-t 2 <br /> N w 0 <br /> Local Contact's Name: SUS \... irYa RA.rl ooo � <br /> , <br /> N ti� <br /> Local Contact's Address: Zj }� R ) I>coCY� W S LZ )Sia .Z LA <br /> City State Zip v D <br /> Local Contact's Telephone Number: f CaS))442_-1 14)3-A ? <br /> cA N <br /> Most Recent Burnett County License Number: STR- NA State License Number:OW -CC4T'EP o <br /> N tyL <br /> t3, t7 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: tia <br /> WC 01L, censc e--t. ‘c-e. 5 1 -'31- 13 . ..z 70 r <br /> DGC,u'QanGJ \‘‘M ;')- '\O 2 ? GO?IC,t 1AG1Jc_,\►n� c11;10\r-e,n • c, s, <br /> Ln <br /> z lc <br /> • G,3`, e,\;ne S 'ca be, ?os-k-c_ b 4 -30 - 22.. <br /> • Nee-6 �c-c(') ;i' -or /VocNlnecr\ wood she \-0 6 -3d - 22 • <br /> Pi <br /> Fee Rec:3(]'j <br /> 8 5 - 5 <br /> Date of staff site visit: S —2- 2.2.- Initials of site visit staff: K L <br /> �,/ f . <br /> LICENSE APPROVED BY : .. �(,GC Q�,( �f/V DATE: 3 -- 22 - 2 2 a m J <br /> ml <br /> LAND SERVICES OFFICIAL °�� m m D <br /> K 53 <br /> oa — gN 0 r <br /> be o = <br /> Page 1 of 3 17 '" C< <br /> - 3 Ns <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2020 '4 a ��LII <br /> x <br /> 'n <br /> Cl <br />