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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r r <br /> 0- CD A. <br /> Applicant Complete All Sections Below This Line a <br /> e C et <br /> Original License Fee= $300 Renewal License Fee(Annually)=$150 a <br /> �( y� I/ ,, d <br /> Property Owner's Name: CIA-19 r I tiit `[ K.oa-fhe r I ne, -PPer rb n -P nt a n o r <br /> n r ^t �1r <br /> Property Owner's Mailing Address: I t 5°1 t\ l Its i-• R O�l/1 lk., MN 551 E3 <br /> City State <br /> Zt <br /> 0 jProperty Site Address: 25252_ pike, Ex And Rd Ae/b5f e,; w 5i4b9 NW <br /> Applicant's Telephone Number: 6,12 240 01 <br /> 13 o r <br /> gj <br /> Applicant's Email: k-F�e rro y c o► ncoit.c+• h el <br /> **If staff has a question abut this application,you will be contacted via email. Make sure your email address is i o <br /> legible and your email provider will accept emails from the following addresses:@BumettCounty.org and i• <br /> @BurnettCountyWl.gov 5• ,i1 <br /> Legal Description of Property: zJ 2 1,04 I CSM V15 P202.(GDU LO7\ o <br /> Section#: 2.5 Town#: 31 N Range#: I .11 W Town of: Nleen Orl <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 'ro — <br /> t <br /> Q G o <br /> Tax ID#(1-5 digit number;found on tax statement): I �g 13 1. c A <br /> o <br /> . , <br /> Provide Rental Information _ F. <br /> License Year Applied For: Z() 2 3 Amount of Renters Applied For: 4 N >� <br /> Local Contact's Name: a3(e S Q f� 04 I <br /> Local Contact's Address: 2.5 4-1 71" D6 n9 o 101 Rci otei9ster Nf 5T 31 5 d 2 <br /> ,,-- City State Zip N ,c <br /> Local Contact's Telephone Number: 32O-4c�I (0 `59 Z" N G <br /> Most Recent Burnett County License Number: STR- State License Number:Ni hlOR-CNC}GN1✓l N 5 <br /> CP o <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY i <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: q <br /> � <br /> - L►00%-e -eOres ` I 3L I2,02y Q., <br /> z <br /> - Lock arvil daCtA a on ctv-k c- o k- o u -f-i rv\-e.._. 'x <br /> "Oc uoanui ald ciav-v-i-i ►�,o-- �o txu-P-al Pe-cp-e- y s. <br /> x <br /> ▪ M n cc one I� ref <br /> aMteitto) a Fee Rec: <br /> g Ck#: 5-051 <br /> z <br /> 2 > w �_ <br /> Date of staff site visit: 3/z/2o2 J Initials of site visit staff: o Q ' _r T <br /> LICENSE APPROVED BY 4�7� -r-A,( DATE: 3/3/ J o`' CD " CID � <br /> y ne i t <br /> LAND SERVICES OFFICIAL = N q <br /> Pagelof3 ° <br /> Burnett County, WI Short-Term Rental License Application—Rev 12/2022 a Ira <br />