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. - RT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI v r <br /> cr <br /> A <br /> Applicant Complete All Sections Below This Line n y <br /> 0 c eD <br /> Original License Fee=$300 Renewal License Fee(Annually)=$150 a a <br /> o ° <br /> Property Owner's Name: A 5 1-1Y V <br /> rs <br /> Property Owner's Mailing Address: 2(''t l G 5. LIPS ET-7 L A 1Z P t S roc'`)EQ. w( S"t(g y <br /> City State Zip a <br /> roperty Site Address: 2sO$ 3$1' ,1V'S MILS/ iM' 5syo6 < N <br /> vN w <br /> ‘N--..),Applicant's Telephone Number: f 1 - 2 1 d - 6 E S ( r r ' <br /> C <br /> Applicant's Email:&i.Q AA-"'`'"1 G.�✓'� 6 ``4( . c a^" 6- <br /> **If staff has a question about Ms application,you will be contacted via email. Make sure your email address is ° 0 <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and C' g <br /> @BurnettCountyWl.gov Q.eco.rt-m.0 T^ r zg. <br /> Vet. 1 ()• LVZ ° C7 <br /> Legal Description of Property: P a t i A o C. CL -5''n-'-J"""`r N°•--6 0,5 Pot N o (6 O C.2 ' F <br /> Section#: ('� Town#: 3e1 N Range#: � N'1 W Town of: �SK 0 co <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 0° <br /> Tax ID#(1-5 digit number;found on tax statement): VS y b it E A <br /> 0 <br /> Provide Rental Information c <br /> - —• <br /> License Year Applied For: 20 2 3 Amount of Renters Applied For: 6 <br /> Local Contact's Name: 4041 M/I 14-14. f--v N I.!€ g °'0° g <br /> z <br /> Local Contact's Address: 1 q T 13 c 4' it M E v' SN 0 0 I N 9 <br /> ( �3 y 54. <br /> 6 City State Zip N <br /> (o s <br /> Local Contact's Telephone Number: 9-- g <br /> Most Recent Burnett County License Number: STR- 22 6 2 State License Number:N W 612 — Cx$'$S y — N , <br /> W o <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i 0) <br /> b) <br /> -Licui --- -ex Pi its f i3/ / 29 <br /> . <br /> Oftu 2cu C and, adze(-- - tw - no- -b exceed 6 l to z 'r- <br /> Loa cued C,Ira.+ ) or\ .S,Q, c -+Oun k a-(- q,6( - (au- c <br /> - Futk5u3 cuu_ ,'k, c52-(1Crn reluc,trunuArv-E- c <br /> r Fee Rec: /6)52 <br /> o Ck#: l 35— <br /> rrl <br /> n <br /> m <br /> cn <br /> r. I f <br /> (2 /Zl3 Date of staff site visit: . Initials of site visit staff: Kr o <br /> y/y/2023 n ' <br /> LICENSE APPROVED BY �� DATE: m W 0 <br /> En < � <br /> LAND SERVICES OFFICIAL n m m ^' <br /> fail <br /> Page 1 of 3 0 0C N o <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2022 3 w n� <br /> m = """ <br /> m �L J) <br />