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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI v) r <br /> 0 . r <br /> a g eD <br /> Applicant Complete All Sections Below This Line 0 y <br /> Original License Fee= $300 Renewal License Fee(Annually)=$150 <br /> �n y� d c <br /> ,�- <br /> Property Owner's Name: I\ 1 1 10\n,da 13\0 Q V E <br /> .— et <br /> PropertyOwner's MailingAddress: <br /> I. <br /> 5' ,iel is /n C _ .v kV N SS3\ �y <br /> uu n ,� C `,, City State Zip <br /> Property Site Address: S 21p U COvnti 1�U�d 1 o VUvl� , w\ S�a3d N <br /> ^t J to <br /> Applicant's Telephone Number: W ) — 81 S —11 0 5 0 <br /> 6\ouy\ev del @ r o . Co► n 0 - <br /> Applicant's Email: Qrn Q�n d o� co <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and P, <br /> @BurnettCountyWl.gov LOT 2. CSM * 33410 V lb, P115 (6►tV LOT 1 #3 io7Sy r i <br /> 0 <br /> Legal Description of Property: ( d F <br /> 0 <br /> Q c o N <br /> Section#: p Town#: y Q N Range#: �S W Town of: �(� son <br /> �' n WNlit <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ti° ; <br /> C7 <br /> Tax [D#(I-5 digit number;found on tax statement): OI—+-3- li,.n7 l 1 5 cJS11J I7 <br /> �• C <br /> Provide Rental Information p <br /> License Year Applied For: 2.0 22 Amount of Renters Applied For: "s., <br /> 0 <br /> . <br /> �Yy Lc S -t.\-1-e�r ro 1 <br /> Local Contact's Name: VA00 <br /> Q19 V' O day-0, za. Str�,I(1 w \ St-1812 <br /> Local Contact's Address: V `-I Z <br /> p �� - _ �� City State Zip <br /> Local Contact's Telephone Number: G <br /> N,,,,DcvE <br /> ov <br /> Most Recent Burnett County License Number: STR- State License Number: — <br /> w <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o <br /> 01 <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Cn\ <br /> OLl PJ St . ;reS ► I 1 2025 c r-1 .� <br /> Doc,,,,,v0„,„, and acQv'2r-hs=metif- v u+ 40 -ex.c�kd (� { Ple p z <br /> S:q-N # ILL) . DimeAli r i S►2td -Poi- 3 I oarrIS po 5 <br /> omt(/t ,,ad,,✓,,Q,, 40 `QQ ,0 Vl ,✓ `C `„,.. Wlct In e vrlyrt r I L4 d'k" FiC <br /> --3 <br /> U1 <br /> 19 2 f' / b'�/►S►ii ee.vu l'un.�tS 2 <br /> l�� i2�� oz3• �� �eY 1 Fee Rec:dt <br /> DL,,,k .4,i 0.,c6r, VL,Q,t. DA S.iodic- 4-- Ucl. 1t•f l 2 4 112'23 8 Ck#: Fl nl+n <br /> rz <br /> 5�AClver -b rote (,UPda-fed --or only 3 bwtroyris by 12/31 12023 <br /> m <br /> cAk GrteS a �-� <br /> Date of staff site visit: 9 1!2/2023 Initials of site visit staff 71 r <br /> o <br /> w <br /> I q <br /> LICENSE APPROVED BY DATE: lI/�1121) � NW Z ;:t -2 3 ty) <br /> LAND SERVICES OFFICIAL < - <br /> 0 co <br /> m v O =Page l of 3 d co z : <br /> Burnett County,WI Short-Term Rental License Application- Rev 12/2022 „ 3Erni <br /> m <br />