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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI a r r <br /> Applicant Complete All Sections Below This ' e ,, a CD r y <br /> = G rp <br /> Original License Fee= $300 Renewal License Fee ( nually) _ $150 ii <br /> e <br /> § <br /> Property Owner's Name: 9 t\U .k UsCL Ve'(�j I�SC�YI _ cf. <br /> V I ►Y <br /> Property Owner's Mailing Address: (1661 , 1 i)a Al 3) St 12-tia,CtiL@ 10. Jt I'i/..9 y <br /> City State Zip P fie <br /> Property Site Address: �I c� i�` �C��� �U �J��S ( ►C 4 9� o <br /> Applicant's Telephone Number: S- S U`t - -°r. r <br /> . p <br /> CD <br /> Applicant's Email: \ C II <br /> \SG ?i f S�Stn1 Ell . € c rn4 l t , (an -.0 n) <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is b o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 11) z <br /> @BurnettCountyWI.gov �' 5. <br /> In (roJ eLegal Description of Property: 4 Vt� (S T1) If 1 O a t OLk 1 cr} 11.5tn 1.) S p 1 SO l (Di-4 <br /> r , ri 0..'" ' <br /> Section#: as Town#: 39 N Range#: 1 to W Town of: r e e.(\GT.\ `; i <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* °4 <br /> , <br /> F.8 <br /> p o <br /> Tax ID#(1-5 digit number; found on tax statement): 1\i f) < <br /> 0 <br /> Provide Rental Information <br /> License Year Applied For: ?ba►3 Amount of Renters Applied For: ? N i <br /> Local Contact's Name: \f'I\ Ca Jl�Ym °° -• lb <br /> i rt •- o <br /> Local Contact's Address: ..- 1.4 V (1 y,S� 1 Ct R Qt) 3 e r L=; k61 N <br /> City State Zip Z <br /> Local Contact's Telephone Number: 1 1 c S 1 1 U8-v , <br /> Most Recent Burnett County License Number: STR- State License Number: C� H <br /> -�C d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLYH o <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: oq <br /> -Lia-nse )/eires 1 /31/Zozy <br /> - Lock and c l&a rk CMSAM-1'c a+ t ,U -d-i ivt t. z <br /> - Wed_c). k/3-etek4A1Lx ergl p laL L(d ru - kd bkf le I I l2D2L <br /> - Occ *() .ems al-- a -42t r"'L- <br /> u�art�-S no+ <br /> d Fee Rec:1V� <br /> �liS (1�,rmi+ does nb-� i nc lu cLe small ut101 n I�� bnkhDUB Ct+ 8 Ck#: t <br /> '-6x)C b l' ci l. < <br /> ��—J <br /> m <br /> Date of staff site visit: 1 )/o/2cz3 Init' is of site visit staff: l� -I T oup <br /> 0, D U U` <br /> � j <br /> LICENSE APPROVED BY ATE: 1111l2O2 -c o inn <br /> LAND SERVICES OFFICIAL r o o c/c <br /> Page l of 3 �( <br /> LA)- <br /> Burnett County,WI Short-Term Rental License Application-Rev 12/2022 J, <br />