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S►e ORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r <br /> a & n <br /> Applicant Complete All Sections Below This Line y• . y <br /> Original License Fee= $300 Renewal License Fee(Annually)=$150 a <br /> d <br /> _ ° <br /> Property Owner's Name: �V t e Z.t1 CT V e- - �,C `'' cr <br /> Property Owner's Mailing Address: �1 . I u 1 0 4,Ne S t CV\CO,tfiie-kt Pt (J-712_ 6 " 1 <br /> City State Zip <br /> Property Site Address: l L I (✓\i y--ec�-‘ P`' '1 , S pccir - L k E '- o 1 0 <br /> Applicant's Telephone Number: 50 1 GI S 1 o1.\rS' io ° W ce <br /> PD. <br /> Y`. <br /> Applicant's Email: Q r no-c-k-5 Q `j 0-4,00, CJ--N <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is v i <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and <br /> @BurnettCountyWI.gov t a I <br /> - - q\ <br /> Legal Description of Property: h -t � � '`^ � '+e, d <br /> Section#: Town#: N Range#: W Town of: Rat _ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C (1N N . <br /> ` <br /> Tax ID#(1-5 digit number;found on tax statement): I rJq Fj� . < <br /> 0 <br /> Provide Rental Information <br /> License Year Applied For: Gq0 Amount of Renters Applied For: 6c):?:;'(-5 <br /> ro ` <br /> Local Contact's Name: S S\to DeJ -1 Q0 <br /> � <br /> 1 0 <br /> Local Contact's Address: \A ko ko-10 Co.tr 4t R W y A , Spoor v.)-i- ) \ 54-2 0 1 <br /> City State Zip (k) W <br /> Local Contact's Telephone Number: 1 iS a 6s \ ' W <br /> Most Recent Burnett County License Number: STR- State License Number:M1:01.-4-CUGLM L N AD <br /> —C d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 3 <br /> •L-i cuts{ €x i►reS 1 i 31 J 2D25 Q <br /> • -i- r- •Ilk,\ - 1,ictS -b jcle. Secured- -I44 i pad 04c6, Qe+ a <br /> - :tyvv-. <br /> Dn.� P, Fee Reo'3(�� <br /> - 1 I�0W Gal'' pp Ll cue n S l n0 l�tt u rvvun-�S 6 Ck#: 5 2 <br /> m <br /> p4 <br /> C <br /> n <br /> m <br /> (ID <br /> Date of staff site visit: f/z/z3 I ICJ I20Z3 Initials of site visit staff: <br /> o %) <br /> IL)/6 <br /> r <br /> LICENSE APPROVED BY4.--- --biAdt--€V DATE:`vl/(/2bZ3 c co b <br /> LAND SERVICES OFFICIAL n 0 c N tffl <br /> e 0 2 ti <br /> Page 1of3 �, ="Cl N <br /> c N <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2022 6�, cs <br />