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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI . r. r-,
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<br /> Applicant Complete All Sections Below This Line r <1 :
<br /> Original License Fee= $300 Renewal License Fee (Annually) = $150 a
<br /> Property Owner's Name: Cy,,.vtj_ Propvltis LLC F
<br /> Property Owner's Mailing Address: d-IRLA.�% s1e,,,Pi° /h.vc- Fc r—•v1+.+4�-tu.1 MAi 55c4-9
<br /> City 0 State Zip (19 1-3
<br /> Property Site Address: a-lytel p..-.`F )sa.r{ ; 5 s 9..,o6. F,.L-:, I,.s; 5'-t 1 o
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<br /> Applicant's Telephone Number: Co tZ 2_bL 13G,l ti P. r- ,.4
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<br /> Applicant's Email: ,v,.rr,r W c-►b I n.over 2:5 (u y,^-,cis I. (..e -.
<br /> **If staff has a question about this applicatfbn,you will be c`entacted via email. Make sure your email address is rn £
<br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and
<br /> @BurnettCountyWl.gov g I _
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<br /> Legal Description of Property:ccA -‘, e t o k. St G tZ T 3 l,N -R‘is W o N
<br /> N .Z.Section#: �'Z Town#: 3, N ange#: %Ss W Town of: -,•y,A„ �,�e� 0 ar
<br /> *Attach additional page if needed fbr lengthy description OR attach a copy of the deed OR attach tax system property page.* `O n N (I,
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<br /> Tax ID#(1-5 digit number;found on tax statement): d 3 5$ �2. y"�c-1f.
<br /> Provide Rental Information cn
<br /> License Year Applied For: Zp 2,3 Amount of Renters Applied For: g it/ W ' `"
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<br /> Local Contact's Name: ,�•,
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<br /> Local Contact's Address: 11 I e SQi - 1 k.4 Q,,,,,a_ .r,,Z,..ti ti_. .. s3-1 t
<br /> City State Zip
<br /> Local Contact's Telephone Number: Co‘2„ plat— A,Z� 2
<br /> Most Recent Burnett County License Number:_STR- State License Number:m -r u©P gV N w x
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY
<br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: H , N
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<br /> O °CLLA1 MIU-'`( oUnd ad.v 2,r-FtS-e.✓ .XL+ y o4- --io -ex eA pi p ,t, Oco
<br /> 511-23-60
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<br /> •VIf kc tc rni-y`(q( n m Fee Rec: (*--3
<br /> Jam. Ck#:ID31
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<br /> Date of staff'site visit: Z Initials of site visit staff: , w Inn'
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<br /> LICENSE APPROVED BY DATE: `/I(/ ZDZ3 < 3 Z
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<br /> LAND SERVICES OFFICIAL < v o co
<br /> Page 1 of 3 4 �,
<br /> Burnett County, WI Short-Term Rental License Application—Rev 12/2022 i `"' Effl
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