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c., r C" <br /> a F, A <br /> eD <br /> SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI ,, z <br /> ° c A <br /> Applicant Complete All Sections Below This Line a a. <br /> o <br /> Original License Fee = $300 Cr Renewal License Fee (Annually) = $150 eD <br /> Property Owner's Name: A S N G 1- Y IVI 7 0-3Property Owner's Mailing Address: It ZSO i Cl'`' ftV-S (11I N N En PO c l S in N C'it)b o 70 <br /> T LR City State Zipu <br /> Property Site Address: 2<<` 0 $ 1.145eT Y- R•D• 5 Poor461. WI 5y Q/ � oo` <br /> Applicant's Telephone Number: 9 C 2. -Zy 0-688 6 ° N <br /> x o <br /> b 0 <br /> Applicant's Email: at$h tel Phut ow ti at+ Go Mom;I. e sly" <br /> g. <br /> Legal Description of Property: P C L A 1 S n'\ V 6- T 2-‘2. d wo <br /> w <br /> Section#: 13 Town#: 3 a N Range#: Ly W Town of: v SY-($`iR N c11-.. CO v�Il'Y" `-°E. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o°c - N <br /> d o <br /> Tax ID#(1-5 digit number;found on tax statement): 1 5 14 0 a <br /> Provide Rental Information ° <br /> CO sh. <br /> • <br /> License Year Applied For: 26 Z-Z Amount of Renters Applied For: r` . <br /> Local Contact's Name: N0VTIteq-N 1?4.NTA L. C6c. `° <br /> }} p � <br /> Local Contact's Address: u! S 11 (1. �1�/• Mc �� NI SLj00 ! N z <br /> '' G. City State Zip <br /> Local Contact's Telephone Number: II <br /> 3`1 3- " � g LL,, /�� [/ <br /> Most Recent Burnett County License Number: STR- State License Number:NIVOR-` 1 -3 <br /> �' X <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ci , <br /> iVet,✓ DecJt Yeees lad usc- ptem 1.1- 6/02-3 -s) <br /> Lr, -. Lit4;a is be c4 Q /le,y} ,-,,ls ec-f)c),-1 z <br /> )- ?Icce ca4 heal 01,0%4 aof ret.lice_ b2 the o ,;fsfc <br /> x <br /> 8 ,� <br /> r Fee Rec3(.7�— <br /> F GC<_. C7 <br /> tri <br /> xi <br /> Date of staff site visit: 9 / 99/ c iti l f si visit staff: pz- < <br /> tr,7 <br /> LICENSE APPROVED BY :till DATE: 1 (l9 l? -1 --� <br /> w u <br /> LAND SERVICES OFFICIAL z u- C <br /> -< m c % (S <br /> z 0 3 <br /> tri a) (JUII <br /> m N <br /> n N., <br /> < Do = <br /> m me ;•.) <br /> Page 1 of 3 ° Z :; <br /> Burnett County,WI Short-Term Rental License Application—Rev 4/2018 . � R <br /> m L. �� <br />