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SHORT-TERM RENTAL LICENSE APPLICATION - Burnett County, WI r to <br /> Applicant Complete All Sections Below This Line D <br /> s <br /> Original License Fee= $300 Renewal License Fee(Annually) = $150 z <br /> nn I <br /> I <br /> Property Owner's Name: vim m he)elpt !n ! <br /> Property Owner's Mailing Address: t f Z 5 I c�V IOCcI UAYve i VVb�GM1 jv' 1 Y 55)2 / <br /> C'ty Sae Zip `t y <br /> Property Site Address: 23 9)-3 I- AZoroJ" /JA ) 5licll �J ()date <br /> 91€5 -i ( o \ <br /> <, w <br /> Applicant's Telephone Number: CI G)2 H 5 I I 6 5_ r '`, <br /> V lC J 0 r , <br /> Applicant's Email: R� re-�� �'� l J�o �j G&J l ) C. �l S\ <br /> **lf staff has a question about this ap lication,you will be contacted via en i1. Make sure your email address is rr 0 <br /> legible and your email provider will accept emails from the following addresses:@ BurnettCounty.org and R <br /> @BurnettCountyWl.gov L o4 Z (cm 5i5 Vol!Z I 5. <br /> 5 <br /> P25? AS Dom 178055 <br /> r <br /> Legal Description of Property: ((N cloy(,on g r 9) a <br /> Section#: V) Town#: 3o N Ra ge#: ) W own of: t eidv-/ o Ei .N 1_ + <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax systern property page.* - 1 w <br /> r U c <br /> Tax ID (1-5 digit number;found on tax statement): 3a 55 . <br /> 0 <br /> Provide Rental Information <br /> _ <br /> License Year Applied For: Za Z Amount of Renters Applied For: <br /> Local Contact's Name: Ko, J ec 15 O 1 �� <br /> , A, o <br /> Local Contact's Address: 5 3. ) )c10c )c P,06tj WC bj J Vv) cLl b`j !v <br /> City State Zip 1 oQ �' <br /> Local Contact's Telephone Number: 32(✓ -�q G9 b 2, NN <br /> Most Recent Burnett County License Number:_STR= 2 State License Number: J W A T -CV'D -_ • , V <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 6I4- 66-- 5 <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: -� ( CA <br /> -I/II-�'1 - -eXPi( S '/3i /Zo2}-I R <br /> - (/Uc,k aid aie,CA 0 on Swh'c at a u -Hine_ <br /> - DcwfafCA/ aru,1 Octiv+isextu -f- n of -b tx-cu4 pwple <br /> 5 1 <br /> r elI <br /> 1,ew CUU I �.�5/� ('-e,rvu�L F Fee Rec: /' cozz Ck#: 107 <br /> riS <br /> l J <br /> Date of staff site visit: 3i)5)2023 Initials of site visit staff: I T HI Q <br /> LICENSE APPROVED BY :I- /tt( DATE: 3 1Z2/2013 , <.. `� v. <br /> LAND SERVICES OFFICIAL o o ti 'M <br /> Page l of 3 • a <br /> w <br /> Burnett County, WI Short-Term Rental License Application—Rev 12/2022 3 Ira <br /> )) <br />