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' G r r" <br /> A. <br /> SHORT-TERM RENTAL LICENSE APPLICATION-Burnett County, WI " = <br /> F g <br /> Applicant Complete All Sections Below This Line c <br /> d 5 <br /> CD Zr <br /> Original License Fee= $300 Renewal License Fee (Annually) = $150 <br /> Property Owner's Name: Def .i <br /> Property Owner's Mailing Address: 5155 G rated uoo d ?I (A) La C,ro ss e Va $q(&o 1 N <br /> ,, City _ State Zip N <br /> Property Site Address: 117 2-- W PC 11^,-1- Rd Spo d Y!Or/ C,(.,)1E S q kO ; = _r. 01 <br /> Applicant's Telephone Number: (715) SS - d 52 ( <br /> . d <br /> Applicant's Email: pa,I S I tor of re al$ 5 CA J I, P. <br /> Legal Description of Property: J e,._( T c e4 She ei) <br /> 5' -- <br /> Section#: 25 Town#: 40 N Range#: ('} W Town of: S CA 'L �' , <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c w 6 <br /> Tax ID#(1-5 digit number;found on tax statement): gg-31,74 i 5 7 (c fit/..) C W <br /> Provide Rental Information ` °' o c <br /> License Year Applied For: 2-012- 2023 Amount of Renters Applied For: / 7%` 4'4►'.'r 'w 'd -J q ` <br /> 'IV " - ,2Z ci>-°_, % <br /> Local Contact's Name: Jt:',-(2r-e,9 Tru..Q,r .. a. <br /> am. hi s g(p(� N <br /> Local Contact's Address: LSD 23` `Q jtYe of Tice- L <br /> City State Zip K1 <br /> Local Contact's Telephone Number: 7155. Co5 7. © '23 I <br /> Most Recent Burnett County License Number: STR- State License Number: 1.11 If. 13k/AT-(XI V <br /> co <br /> x <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: c <br /> gr et# G.(I L,ceiccilrer -' ' <br /> F'Ivy k- 40 eKceel 1 a ., z ,... (`;NI <br /> 0n I M a ✓► d w[/(; reii-k +J it, <br /> Fee Rec:3D,m <br /> g Ck#: 101 <br /> Date of staff site visit: 9 /I I a d , � t'! �f site visit staff: <br /> f i , / .. <br /> CD <br /> LICENSE APPROVED BY : / DATE: CI /30/? <br /> LAND SERVICES OFFICIAL // ; 'a A <br /> iii <br /> mW C <br /> GI <br /> ' mom <br /> co -- Ilifil <br /> 00 <br /> c <br /> Page l of 3 'S N Q <br /> Burnett County, WI Short-Term Rental License Application—Rev 03-2022 2^ ' <br /> OWx <br /> J) <br />