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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI = r <br /> Applicant Complete All Sections Below This Line . iT = <br /> g v, ft <br /> Original License Fee= $300 Renewal License Fee (Annually) = $150 Cl. <br /> Property Owner's Name: Ka nd K / rey2et`h ems$ Li_(� C C. <br /> A� � Ll _ 3 <br /> Property Owner's Mailing Address: 2-00 Met pte .Si-. ►-1 CO17(X S M AI 5-50 3 <br /> Cif <br /> y y State Zi a <br /> Property Site Address: / 70 7 Mir). e►^ V c - C i Dan b j,j {1/r . if -3O o <br /> N <br /> _ W <br /> Applicant's Telephone Number: &57 -0a-7-'" j 3_3 c <br /> Applicant's Email: Ka n cI k peeper-fi esI735 0 (g 7a//, co in <br /> CD <br /> **If staff has a question about this Application,you will be contacted Jia'email. Make sure your email address is I — r o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and ft § <br /> @BurnettCountyWl.gov L Gov2 -9 /-4, <br /> ^ l _ <br /> Legal Description of Property: 0 7 -- 032 _ G -9 / -4v `36. j O 5 —001 --0 j(70d , d <br /> ri <br /> Section#: 310 Town#: 4 ) N Range#: 110 W Town of: Bow 1t.( . -...SW/SS o,N - <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 7Q <br /> Tax ID#(1-5 digit number; found on tax stetemegt): t 3 12 a2 k ''s A o i i <br /> I o <br /> _ Pr'ovide Rental Information <br /> 7a <br /> License Year Applied F r:202 3 0 Amount of Renters Applied For: N <br /> Local Contact's Name: 1 t /SI') S C.-4 Z C) ro c <br /> R r <br /> pg, 1 �" z <br /> Local Contact's Address: W� OVS )oi-ve/� R %�LG d Afr 59 i'0 o <br /> City State Zip <br /> Local Contact's Telephone Number: 11 -5 20 e3 ) 9 I <br /> Most Recent Burnett County License Number: STRIA' State License Number:ikST 2 Dkf <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> - L,' c , \ .2k,pi ire.S ' 131`2ou( -C t N <br /> - 'c nq us-f ke Io b d c�-F Of -H - z w x <br /> -Oa/461404 v D+ -t-o Maxi (9 p-c}�-fie- , can (AI-14A ocloo-svme i+ <br /> w.ec-i-tkvr parr 1 IcocacA <br /> rd Year 2►'t tn(k dt occu.panui ll'rn4 cA <br /> C(Xgt+1 Con-iti arta l I cice Yurribr,r i em eil eriL`'( 1 oc-U,l c0(14-1(-- , set I C-►`►?r- (L) 0-6 F Fee Rec:3 0 _ <br /> o Ck#: <br /> !,;Lutio9e�1,,,�rer►�,Q,, , <br /> 6PAiltillidl‘ 4 c.) <br /> Date of staff site visit: /6 2a3 In ials of site visit staff: 3 KT- <br /> Z� z Ca <br /> LICENSE APPROVED BY DATE: ✓ Zol2�Z3 m < 0 <br /> LAND SERVICES OFFICIAL m m m cm IND <br /> < ao �' o <br /> Page 1 of 3 ti, 2 <br /> Burnett County, WI Short-Term Rental License Application— Rev 12/2022 i i ` <br /> mMI <br /> .)�` Ji <br /> m <br />