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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI v) r r~ <br /> a' g A <br /> eD <br /> . Applicant Complete All Sections Below This Line y <br /> CO <br /> o. c A <br /> Original License Fee= $300 Renewal License Fee(Annually)=$150 s. Z <br /> (� ,,,E' B <br /> Property Owner's Name: S LlS(3t_) Cz.r\CS, \ \I CQ 0 c31.,c r1 S c <br /> nn W :h <br /> Property Owner's Mailing Address: )1 1 l, (l* NS rpc . t-C C fc>_-r' Sq \ \ 71 <br /> 2,-1 O 4 O City' State Zip p�.1 <br /> Property Site Address: E -} C CL c�. pt ,c C�.`1 UCi S�l`t��\ 0 6 <br /> , <br /> Applicant's Telephone Number: - LN a- \psi'-)" i W <br /> E <br /> Applicant's Email: & \D .`�S�S°\ € c c.ii\,C itiYl <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is 2 <br /> legible and your email provider will accept emails from the following addresses: nBurnettCounty.org and �- <br /> njBurnettCountyWh.gov �:kC�'&d (�-; S �," <br /> {- uc C -.4\A \ c1 Z c2-R1 hoc Lk�i4s1 �' r <br /> Legal Description of Property: �}' `` <br /> Section#: ca Town#: N Range#: 14 W Town of: -Rust-, (SW NE) v lv <br /> E. W <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p0 — <br /> Tax ID#(1-5 digit number,found on tax statement): 3. 4-\t y , E. K <br /> c <br /> Provide Rental Information 10 j <br /> _ <br /> License Year Applied For: Q 0 a Amount of Renters Applied For: a > _I ,< <br /> Local Contact's Name: U e. 4 rkti1 u 'Cl S I <br /> 00 g <br /> `� n ' za 7- <br /> Local Contact's Address: a1 I. 0_.k-v, k0C.6 Pt , �PC::0<1e, J 4`g0 1 1 <br /> I" ',` '' City State Zip <br /> Local Contact's Telephone Number: .b\ - -1ii(i t-'\C - t <br /> ( <br /> Most Recent Burnett CountyLicense Number: STR- as-VS State License Number: <br /> 0'v\l T CCyIEfu. e <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY c <br /> THIS LICENSE IS SUBJECT TO ALL LCONDITIONS LISTED BELOW: W <br /> —� No Tz excre. 4 J ! o 2 B GLt l�4`L \i' <br /> 1k 5 l/ e- cls f i ive-5 /— 3/— Zo z, K ,,, <br /> Fee Rec: `..tiff <br /> 8 Ck#: 1.03 <br /> rxi <br /> Date of staff site visit: 7/C ,, t2 LZ Initials of site visit staff: /// o m 1.D U <br /> �� z C <br /> LICENSE APPROVED BY DATE: 3 Z//20 a j '� <. <br /> � rt <br /> N <br /> ff <br /> LAND SERVICES OFFICIAL m o 2 = <br /> s< w <br /> Page 1 of 3 N <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2022 '4 <br />