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SHORT-TERM RENTAL LICENSE APPLICATION - Burnett County. WI r~ r <br /> r -. <br /> Cr <br /> Applicant Complete All Sections Below This Line <br /> Original License Fee=$300 Renewal License Fee (Annually) =$150 z 2.cc <br /> tj /1ej-er i r <br /> Property Owner's Name: JAL v/ � � C <br /> add/ kV i' 7— M/ Al 53 6 •, <br /> Property Owner's Mailing Address: � N �� � <br /> y 2 757 S /e!tz. f?d rrf b.'y WiT s 3 0 t <br /> Property Site Address: <br /> < (J N <br /> �/ Q - W W <br /> Applicant's Telephone Number: 1 7�3 ` < //. o <br /> r- <br /> n / J <br /> Applicant's Email: z rev p rO pet )-t Q 0/nQ./[ ., com <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is til 0 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and . <br /> @BurnettCountyWl.gov o• <br /> Legal Description of Property/'I+1S V Ijec k 5v 1l A Detu/fS Iiae l t i S /O l/,IL E A/ o d Q <br /> Section#: 3 3 Town#:4/0/if N Range#:/6 W W Town of: bang.")0 = - <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O n - 4_ <br /> Tax ID#(1-5 digit number;found on tax statement): ,...3'4/3 / 1 '' A .—} <br /> 7 Provide Rental Information in C` <br /> License Year Applied For: ?0�J Amount of Renters Applied For: g IIIJ-e-S'•-15 <br /> Local Contact's Name: f 1 C'` ci r 7-e s D/1 IA . <br /> Local Contact's Address:VI 53 0[2'6— 519h/)Sv n i vKe- 1.G w?Loiv- ti)Z 9 <br /> /� City State Zip <br /> Local Contact's Telephone Number: (� _ 4 7� - ` 0© � <br /> 4 CD <br /> v " <br /> Most Recent Burnett County License Number: STR- '9'- " /,3 State License Number:f a e1?-19 8 PNE 3 w --c x <br /> (A) v <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: • F <br /> W <br /> Li c,2nS e -e>619 i(-e S 1 /3 t/I Zoly _c <br /> Vv <br /> - 1,0d and coo D(' -C-e-Pl'c I- a.te -i-i - <br /> O- CC,u Qanc,y a n c Uer-��-, -y-i n� -�o -f>L�e ed �-�-e . x <br /> - h�S,,1 l <br /> " r Fee Rec:1� <br /> M" A cW i I 02A S-I nil re�(t-)✓`� i► i t S 8 Ck#:I3L <br /> m <br /> A <br /> n <br /> [XI I <br /> Ia ,-- <br /> Date - <br /> Date of staffsite visit: k' l?)2o13 Initials of site v it staff: it 4 1'6 ; inn <br /> 0 0. c_ <br /> LICENSE APPROVED BY : DATE: 3 < g <br /> z <br /> LAND SERVICES OFFICIAL m m o <br /> rn =o r <br /> Page 1 of 3 °< vo <br /> l <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2022 b 3 <br /> ff <br />