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c r <br /> or i9 A. <br /> 94 = A <br /> SHORT-TERM RENTAL LICENSE APPLICATION—Burnett County, WI I: 0 <br /> Applicant Complete All Sections Below This Line o <br /> (&i2ina1 License Fee=$300 Renewal License Fee(Annually)=$150 '—Ncr-Fi <br /> � <br /> Property Owner's Name:Noah &Amy Shadis o <br /> Property Owner's Mailing Address: 234 Van Buren Ave N Hopkins MN 55343 . N" N <br /> City State Zip o (V <br /> Property Site Address:27893 N Point Lake Rd,Webster,WI 54893 <br /> Applicant's Telephone Number:763-221-9287 x <br /> Applicant's Email:noah.shadis@gmail.com w• <br /> r <br /> Lot 13 of CSM V5 P191 (#204054)Map#1082 S28 T4ON R15W CSM V5P 191 t ° Z <br /> Legal Description of Property: Parcel ID#07-012-2-40-15-28-5 05-001-015000 d <br /> co <br /> Section#: 28 Town#: 40 N Range#: 15 W Town of:JacksonN <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system o.pr perty page.* ac ' <br /> \ g n o <br /> Tax ID#(1-5 digit number;found on tax statement): 5$ I a E W <br /> r).• < <br /> Provide Rental Information <br /> License Year Applied For:2022 Amount of Renters Applied For/ L/ - u-k $ <br /> Local Contact's Name: Dan Shadis IW � i <br /> 509 N Park St Grantsburg WI 54840 z P <br /> Local Contact's Address: (- .._ <br /> City State Zip -0 J <br /> Local Contact's Telephone Number: 715-463-5408 kn V) <br /> i N CHSr1'� �_ <br /> Most Recent Burnett CountyLicense Number: STR- State License Number: r ` w <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> ° <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i <br /> $Scr.i►'1 r" 14 ,pec,p/e 4n be c. /Vet ' v ZeGiOf Porte I Can n be u52A �( )t.. I h Abe �'vr civic( 11 <br /> z <br /> ✓►wtu5t— b rep g. cn <br /> ®fir; ✓m.454- 9e,4- a i ffn,,-j-- or be re' e; bt ile.4,e0VS <br /> ..dam a <br /> e1 r<g rNtt/6+ liavG GI eaI+GYIGe cot CN1Cie/!(s� <br /> t �!►VCr Fee Rec:3Or]- <br /> U ko Sh.o� b {e-i- r4�or% i er �1 � Perms, , d Ck#: c: c <br /> // )'-') <br /> N <br /> ate of staff site visit: b 1 I s i visit staff: <br /> rn <br /> / cn <br /> LICENSE APPROVED BY DATE: 1°`/3t??^ z CD <br /> o S giiii <br /> LAND SERVICES OFFICIAL .G a T, <br /> in o_ c <br /> et <br /> rn 00 C.C.Pagelof3 8S r6' <br /> Burnett County,WI Short-Term Rental License Application—Rev 03-2022 b ° <br /> M <br /> MI <br />