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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r r <br /> -. <br /> Applicant Complete All Sections Below This Line a. C CO <br /> H <br /> Original License Fee= $300 Renewal License Fee (Annually) = $150 a <br /> d <br /> Property Owner's Name: \ A_14" Ai , c <br /> � cr <br /> Property Owner's Mailing Address: I 1 ( Vl, t al.J AlliF lvCL -Ci'"t 1110¶SI ....-C-•\> <br /> Property Site Address: (i � e ZCI) \j3 P ity WI Stat5� 3 <br /> \a— 4 <br /> Applicant's Telephone Number: c0 C1- -1\--0iI o <br /> Fi <br /> Applicant's Email: J.' . t 1 q2 y �\A' ( 0 <br /> 0**If staff has a question about this application,you will be co tacted 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 . <br /> @BurnettCountyWl.gov g g. g) <br /> Legal Description of Property: d ` <br /> Section#: � / Town#: 39 N Range#: \ \C W Town of: 1 v! ►l(3)1 <br /> B. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d r.) - rt <br /> Tax ID#(1-5 digit number;found on tax statement): 1 a (3 a g 4-• < a <br /> o11. <br /> Provide Rental Information w <br /> License Year Applied For: C7w3_3 Amount of Renters Applied For: 1 CA <br /> ro <br /> Local Contact's Name: t` C.1 \k{ ICI\J rc&AC4 ao . <br /> Local Contact's Address: ? .. -- V Pve_ --t W V V\ 1 1. 0a z <br /> o C <br /> i , \*\ CK 5 '6,�� City State Zip <br /> Local Contact's Telephone Number: �,(t �t4- <br /> i NI, <br /> Most Recent Burnett County License Number: STR- a —CS 1 State License Number: V M [v 5 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY d <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> lv <br /> _ Li(,Q,�'1S-Q, -e,k0i(6 I I 31 )2D2y <br /> -blrlkh -e cu.n n.of Ix r.erl-{-c d �,l- bu.nk-hou+s-e a5� z <br /> • OCL parur-t 01/4.► 1ci acIV&- -e .il-41+ 11-14)+ -kj -e xc�-e-d 14 ► eopLe <br /> - PI acard du.-�e.d Cy LA # end c�u►�l-� c,��uc, y <br /> o Fee Rec:4J5� �o <br /> 4. `1 t 5.3 y� - 2 I O o Ck#: a-o,�i. <br /> - 11/l eQ,-f a,.( 1 i ce i'l S i'i-b) revia rem -1-5 m <br /> < J <br /> r, l�J <br /> m In/ <br /> �7 ,J� -> a IuLI <br /> Date of staff site visit: L D 2 OZ3 Initials of site visi staff: 14E - ' `T m cait W D 0 <br /> z m - Z <br /> /' J2oa3 <br /> <LICENSE APPROVED BY . 2 a it n inn! <br /> ! <br /> m vo 0 <br /> LAND SERVICES OFFICIAL m v S N <br /> m �`K N <br /> Page 1 of 3 ° CD a `� (TUIl <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2022 3 .. �L JJ <br /> x <br /> m <br /> z <br /> m <br />