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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI C4 r✓ <br /> cr A A <br /> Applicant Complete All Sections Below This Line a CD o <br /> F eo <br /> Original License Fee=$300 Renewal License Fee(Annually)=$150 � C <br /> z <br /> ` f <br /> Property Owner's Name: ii-k'cd L t 3 0� MQ35 4 Ira 62 <br /> Property Owner's Mailing Address: aoaO VI/leas-ant. un Sr•, Jr1dt.K4ti ee A N.55 371 <br /> 0-3I City 1 State Zip <br /> Property Site Address: 1?•3 N0 r 'Ri ve.f 'R0Q4 V4 rt 1 nkr (,JZ 5 y S'3 C <br /> N <br /> W <br /> Applicant's Telephone Number: (01.II ..) go'�—o�5a.S o <br /> Applicant's Email: I MGSSCt rd Q7 ea ri-i/1 Ivlk• h e.� ' �` <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is s i <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and R. <br /> @BurnettCountyWl.gov a. r <br /> Legal Description of Property: N G Ya )1.J e Sk o <br /> Section#: 0% Town#: 110 N Range#: i 7 W Town of: iiiik U ill Df V E- <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system pert))page.* O - <br /> Tax ID#(1-5 digit number;found on tax statement): 2 N <br /> (6 S q < .e k <br /> 0 <br /> Provide Rental Information ZZ. F LA <br /> License Year Applied For: ck,a 3 Amount of Renters Applied For: I <br /> ro <br /> Local Contact's Name: Dart Cwt.(G(' ro <br /> I. <br /> II /� 1 � j�� o <br /> Local Contact's Address: 02 S6 5 `'f Bt uLTC" Y�GI.ke_*et. {�rlc0k rv\ �i(J� c5 y 8'30 <br /> Ci State Zip <br /> Local Contact's Telephone Number: (7(5) g15j-O7Q O .,� <br /> Most Recent Burnett County License Number: STR- State License Number: till DD N -C.N k N r I O i_ 00 .- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> -Lux15-2 JQ.LL i r t \ 131. 12024 - ,%/ <br /> - Ocsiwpcuic -f ouvl oLaw_i*+" nod- -ex 14 ¢c.op z — 0 <br /> x <br /> - P.�v\- cU:k Wt l l Nzs -+-0 1C1-e. PoS-}-ems biL{ mu,1a -trct act cicor <br /> b,,t 1 1 t I zc23. 5-e-e- I.ek -r L.l-- 6(1. Lic zas 1 rn R..ectuA remQ-ntFA <br /> w L� l�V U A 1r1 (� '+"t L- 4-(L.1/� K- IAct c.1,-E ,�. t^A�- r Fee Rec: 1? <br /> - <br /> v Ck#: .?to I <br /> r1 <br /> m <br /> z <br /> m <br /> m <br /> cn <br /> I27 a C7 <br /> Date of staff site visit: Li 1 )2 � Initials of site visit staff: IV <br /> iii <br /> LICENSE APPROVED BY DATE: 9 ) 1 - S. } <br /> 3 LAND SERVICES OFFICIAL . <br /> n c:= <br /> Page 1 of 3 E c c <i <br /> Burnett County,WI Short-Term Rental License Application-Rev 12/2022 will <br /> '7'" w <br /> ' 3 <br />