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CP r rl <br /> ,,..= <br /> `n r. <br /> SHORT-TERM RENTAL LICENSE APPLICATION—Burnett County, WI T. 5 <br /> O cn rD <br /> Applicant Complete All Sections Below This Line °' <br /> d g <br /> Original License Fee = $300 Renewal License Fee (Annually) = $150 <br /> Property Owner's Name: 1 ck rh 17'1 U er f�I y <br /> Property Owner's Mailing Address: 112-L !0> ACd WOU& Cviv(� Vki6O u y 0111 T.J/Z� c N <br /> �" City State Zip r ' <br /> Property Site Address: 23933 �1brDl� Lar-)e 1 c.1] lie, itipf 5`i ] o C R <br /> „.„. <br /> F, u1 <br /> Applicant's Telephone Number: ci 5 2 LI 5 ip -i f 8 5 r <br /> X <br /> 0 <br /> Applicant's Email:11\mllhy)d`e..n'1-a. 152.f 13 O a.i1. tr'i DJ OD <br /> Legal Description of Property: 1,,Ot; CSM 5z 5 V? 55 3 Dt C /75 0 55 d 1 <br /> CD <br /> Section#: 18 Town#: 3e, N Range#: W Town of: be Ne. o `" <br /> . W^C <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach ax system property page.* 00 <br /> dP. , g <br /> Tax ID#(1-5 digit number;found on tax statement): jo�+ 4 w <br /> o <br /> Provide Rental Information r ` <br /> License Year Applied For: 2 e w <br /> pp ��� ^,lAmount of Renters Applied For: <br /> ylp <br /> Local Contact's Name: stGl.c ,i n U c s o n . 9 <br /> yCD <br /> Local Contact's Address: W lD(0 0 COunty H 5 h vv Cly A -40�1i Voj 5y cps <br /> / / City State Zip <br /> Local Contact's Telephone Number: 'r71 5 — Li'LO 2z. <br /> 3 5 1 <br /> Most Recent Burnett County License Number: STR- State License Number: OV/,4 1 'CFOYl.t't '' — tsi <br /> d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: y VJ <br /> 0 fJct 1(4(e Cart 0:41 c404-,",,_ r/`cr7114.16c Pten/e/14014/ <br /> a :11,54 11 Ll ,z,,,,„ rcit.V) dql SI)?/27 s., gmeocip, <br /> r 0 lin - <br /> cn <br /> Cf <br /> r Fee Rec: <br /> / d Ck#: c7 ( <br /> rl <br /> Xi <br /> Date of staff site visit:C/1 �2! 2/ I 'tia i f site visit staff: v <br /> LICENSE APPROVED BY : A L. — ),...... <br /> ' DATE: 8 Ila/e�.- :cr.: �'--� <br /> LAND SERVICES OFFICIAL ., m L . <br /> /[� <br /> tart <br /> (U C `— V V! <br /> < 3 <br /> .q0 �O <br /> • 07• C <br /> Page 1 of 3 °' "`' <br /> ' <br /> Burnett County,WI Short-Term Rental License Application—Rev 03-2022 0 _ 1:::3 ,150 <br />