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C r~ <br /> C A• <br /> N <br /> SHORT-TERM RENTAL LICENSE APPLICATION— Burnett County, WI S: <br /> Applicant Complete All Sections Below This Line v <br /> w g <br /> Original License Fee = $300 Renewal License Fee(Annually) = $150 ro <br /> ` lc ; <br /> Property Owner's Name: ( C �c)�� , d- ..)c c �(a 1 -1 <br /> G) 7d <br /> Property Owner's Mailing Address: k-1 et.j 6j / /Ce-_J.1' J .( 51 '1 (.J 1 S Yr7 <br /> City State Zip ' V <br /> Property Site Address: (,(Q 3 ,).�p�.)n r( ti ( .f\ U3 l rjZ r 8-`Z n <br /> Applicant's Telephone Number: / y <br /> P Lo l -�� aQ k 0 <br /> Applicant's Email: 1 Jed\��Ca- V V 4 Co P, ( „.A , (_o v✓\ r o. n <br /> Legal Description of Property: (p(a �v S Y�� 0 w 11 & �0 3 u: ,-.,--0 P,'.,e' �J t o d <br /> Section#: Town#: N Range#: W Town of: 1\G--"O c I`- P- <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ec <br /> Tax ID#(1-5 digit number;found on tax statement): 1 a CO L/ (_0 a.5. C W JA- <br /> 0 <br /> n Provide Rental Information I' l'i <br /> License Year Applied For: <br /> c�0 Xa Amount of Renters Applied For: $ Y <br /> b <br /> Local Contact's Name: -3:310 �-Z ) I ` mo .lA <br /> z4 <br /> Local Contact's Address: a,\401/4.--j Cp 1„uACc,J; c..,i,--1 '1,-- - 3,rc.n 5 l 1 e7a c ' <br /> City State Zip ; <br /> Local Contact's Telephone Number: 6,I - (p-) - D-0 a,a ik <br /> Most Recent Burnett County License Number: STR- State License Number:D'a)Ai- GAe25g ` <br /> J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: -3 <br /> 0 (C4 4 be. ,rev / )er-i) +0 ere- -1-444 10 peof k-- <br /> i writ 5 1; ce"e Cl i f S 1131 I -3 r z <br /> 3 R� ( u.ae 1.4/c s are. ( yer ✓e -1444 . Dc- re�?e wa I c� i c� I� a <br /> iivtO / <br /> �. e ;b 1e ?el �'e h,f + !dr . x r <br /> 0.., <br /> v � �y� <br /> r Fee ec:$30 <br /> d CLteci Jou• <br /> � l -- <br /> Date of staff site visit: 6 / l j' i ?? Initial e visit staff: �v I=1 ., <br /> / � m <br /> LICENSE APPROVED BY : DATE: jj 1 3 I Lam.1 ,g' <br /> LAND SERVICES OFFICIAL — 4- 0 o <br /> i:i_ c <br /> c <br /> Page 1 of 3 -J <br /> Burnett County, WI Short-Term Rental License Application— Rev 12/2020 CD <br /> x <br /> rr <br /> x <br /> m <br />