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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI G r r <br /> 1.. <br /> 9. CD n <br /> ' Applicant Complete All Sections Below This Line y. p <br /> °o c eD <br /> Original License Fee= $300 Renewal License Fee (Annually) = $150 ,- B. a <br /> /�, / d <br /> Property Owner's Name: / "ii L��,q,.. a. /C/ kid v 6 c l.� `D gr <br /> /� <br /> Property Owner's Mailing Address: / ' e'.3 & /ii d : Ti �v a., , 5-YB,7 <br /> City State Zip <br /> Property Site Address: 3 �� - ���+� W • 5 ci‹S 3(3 o r <br /> ' 7 5-- 76 .-1 & o W <br /> Applicant's Telephone Number:/ !/ `7 6/0 <br /> / r ul <br /> Applicant's Email: f<am J► c C 1� ire 5 P �t IL <br /> el �: C704/,/( ' Cei vc ON m <br /> If staff has a question about this application,you will be contacted via email. Make sure your email address is o 0 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and g <br /> @BurnettCountyWl.gov 6' <br /> Legal Description of Property: fl I412-c)i,C c-\ "7"-A,k ✓ Se rn. d <br /> Section#: b2. Town#: go N Range#: I 1.9 W Town of: Oak..14nd r n <br /> *Attach additional page if needed for lengthy description Utt attach a copy of the deed OR attach tax system property page.* d I -� <br /> C 3. a <br /> Tax ID#(1-5 digit number;found on tax statement): I Z7 5�j _ <br /> Provide Rental Information 'p o <br /> N N ETLicense Year Applied For: 6 2 Amount of Renters Applied For: W t. <br /> -Z <br /> Local Contact's Name: c-Lh)i--, G4-vscj ilt Cri "Q 1 SL <br /> Local Contact's Address: /1'Z. GUI' S T" ti 1 r� e x. R ��` ✓V O/7 <br /> / City State Zip O <br /> Local Contact's Telephone Number: 7/5-�7z c:) lS J Y <br /> Most Recent Burnett County License Number: STR- State License Number:N I/0k-afiriliZ N —'' <br /> NWoR• CQRRf1V1Z N g <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY c <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> -Lic Ekpi/'CS t i3i JZaLt a cP <br /> w <br /> -Lock and atiui r1 04 Ste-'C -fit k a Ca,/ ►'v-z_. xi <br /> -0(c u fail 1 anpt advt,✓- lSRATU n.- - nod- -to e xce, d Le (ae- pL i� <br /> •keitia t,6 1Q,l i f S -to 2,e. p53-1-e.cl vij ct-r yytfkiiA tr-f-ra ce, d' by m , <br /> Fee Rec:73(50-431 <br /> g 11 )2o2 ee.S. S L 44Cr (t- �"f s Li c ul S i'10 R c?(A,;r�� o Ck#: f (t <br /> cA <br /> Di <br /> •tu c jcor v4mbin) -lo be r-rnovtd bk./ [e/►/zoz3 <br /> Date of staff site visit: 3 15 21)Z3 I itials of site visit staff: KT— .Q <br /> LICENSE APPROVED BY . DATE: 3)Z B 2 3 m W< 3 70 <br /> LAND SERVICES OFFICIAL �0 0 0 <br /> cD g N <br /> Pagel of 3 '. '<3 w <br /> Burnett County, WI Short-Term Rental License Application—Rev 12/2022 <br />