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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI v) r
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<br /> Applicant Complete All Sections Below This Line 0 y
<br /> Original License Fee= $300 Renewal License Fee(Annually)=$150
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<br /> Property Owner's Name: I\ 1 1 10\n,da 13\0 Q V E
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<br /> PropertyOwner's MailingAddress:
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<br /> 5' ,iel is /n C _ .v kV N SS3\ �y
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<br /> Property Site Address: S 21p U COvnti 1�U�d 1 o VUvl� , w\ S�a3d N
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<br /> Applicant's Telephone Number: W ) — 81 S —11 0 5 0
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<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
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<br /> Legal Description of Property: ( d F
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<br /> Section#: p Town#: y Q N Range#: �S W Town of: �(� son
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<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ti° ;
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<br /> Tax [D#(I-5 digit number;found on tax statement): OI—+-3- li,.n7 l 1 5 cJS11J I7
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<br /> Provide Rental Information p
<br /> License Year Applied For: 2.0 22 Amount of Renters Applied For: "s.,
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<br /> Local Contact's Name: VA00
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<br /> Local Contact's Address: V `-I Z
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<br /> Local Contact's Telephone Number: G
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<br /> Most Recent Burnett County License Number: STR- State License Number: —
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<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o
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<br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Cn\
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<br /> 5�AClver -b rote (,UPda-fed --or only 3 bwtroyris by 12/31 12023
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<br /> Date of staff site visit: 9 1!2/2023 Initials of site visit staff 71 r
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<br /> LICENSE APPROVED BY DATE: lI/�1121) � NW Z ;:t -2 3 ty)
<br /> LAND SERVICES OFFICIAL < -
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<br /> Burnett County,WI Short-Term Rental License Application- Rev 12/2022 „ 3Erni
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