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s _ r <br /> SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI 1: = <br /> c <br /> Applicant Complete All Sections Below This Line p g- <br /> C <br /> Original License Fee= $300 Renewal License Fee (Annually) = $150 •2.- Cr <br /> � <br /> Property Owner's Name: LZ U\v\Gk LI 0 VA \ �Y \YC z <br /> Property Owner's Mailing Address: 84 d N to/�(� [\ ) :550(ie , N <br /> d C ��Y 1 fJ�i City w cJ State L � c i <br /> Property Site Address:6,9- 6 c c <br /> Applicant's Telephone Number: (p5 �\ <br /> V - Li 1-1 c X <br /> Applicant's Email: \(1\1(1\ , ,i e1/4r W\Yl fecyro,1\ ,(0 Y r l ' <br /> i . <br /> Legal Description of Property: 1 ^ v� 1 o <br /> ro <br /> Section#: \ Town#: V N Range#: `t5 W Town of: Q O.U1- N F-- <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* —� <br /> `+ n N <br /> Tax ID#(1-5 digit number; found on tax statement): 6- (.05- 311/('�(V <br /> I o <br /> Provide Rental Information / c4, ,\(' <br /> License Year Applied For: C'.. Amount of Renters Applied or: ( p <br /> Local Contact's Name: YY),S fa cod(( \ SC ) owl St v„ i 1 <br /> Local Contact's Address: �� ' �V S �L S''Y,e.�� � l ,.e� �NZ � 1 ° 'S <br /> �^ t ^ City State Zip <br /> 4 I s- O <br /> Local Contact's Telephone Number: pL —a LA`L tel. Q <br /> Most Recent Burnett County License Number:_STR- State License Number:OW: C Vine <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1/4.)1 <br /> 0?I4.ceCA,rc i6 ri d rte"r ina;it eXdAflce C_ <br /> p/i t 6 Iet�x a llv,-✓ iv be tie rd's 4-e, z �1 <br /> 7, n <br /> CA <br /> CA <br /> U Fee Rec: <br /> 8 Ck#: = <br /> Date of staff site visit: L//26 I'?9. I.-IL <br /> Ii o e staff: <br /> r ` cn rn <br /> �1�`( .tel <br /> LICENSE APPROVED BYcn <br /> DATE: /?6/?-d A w <br /> ,, a <br /> LAND SERVICES OFFICIAL o c C <br /> <•3 <br /> (A <br /> m G O co <br /> ID C <br /> Page 1 of 3 d 17 4/4� << <br /> Burnett County, WI Short-Term Rental License Application—Rev 03-2022 4 CD <br /> Jrll <br /> LTJ <br />