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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r <br /> a n <br /> Applicant Complete All Sections Below This Line �`�• y <br /> O G eD <br /> Original License Fee= $300 Renewal License Fee (Annually)= $150 ,- a. <br /> , g d — <br /> / ff <br /> Property Owner's Name: /1 UC11r, /fa `°- ._a' <br /> 71 <br /> eD <br /> Property Owner's Mailing Address: e./a/7 toicoei 1grs' C f r111 e,Jc i,s 1J .5 S 11t? y <br /> City State Zip <br /> Property Site Address: :23/37 / 20(--1n /-0-4 Shei1 C ake W ) 5 Lj 7 I o N <br /> w <br /> Applicant's Telephone Number: ( i ) 7/2- 0!>/(o r <br /> 9. r <br /> Applicant's Email: ocla art ci. Y 1t?j ?- ?a I. <br /> CI <br /> **If staff has a question about this applic ion,you will be contacted via email. Make sure your email address is tii o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and ' <br /> @BurnettCountyWl.gov r 7 <br /> Legal Description of Property: L o4- 2 CS m sy,5 VOL 2 P 2 c ? o d r` <br /> :° 1, <br /> Section#: I ' Town#: 3 g N Range#: I y W Town of: 0 e )Q y V N w <br /> 16 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* r . <br /> Tax ID#(1-5 digit number;found on tax statement): 3 2 c s— 5. A ii <br /> . <br /> Provide Rental Information P <br /> License Year Applied For: e;'.23 Amount of Renters Applied For: . <br /> Local Contact's Name: eCt J I2t_ G/Sg--ei 00 <br /> z <br /> Local Contact's Address: C 7/3 /Jo:1lalq C oacil ehskr- w) 51193 IV i <br /> City State Zip D <br /> Local Contact's Telephone Number: (3 2®) t-(91(.,' _S_92 3 N <br /> u <br /> Most Recent Burnett County License Number:_STR- State License Number: Jv tiklOR-CXR M X A) <br /> v <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: NI <br /> W <br /> OLiCQ.re wines 1`31)2o26 0,' 01 <br /> dccw 19anc,LI cad adtiv-i& <br /> 3 c Con �t�c�� r ,( l�+c�P,�-+'1�S (715-30"Z d o9) <br /> x,�r - Ctx���`j 5 -c <br /> �! Pel o la Over t eCk needs aii ac =�' -1.o ort e.Q - el, r� ►'-� <br /> x <br /> Dy d <br /> by 3 r Fee Rec:- 43 <br /> I1I202y o Ck#: C "7 <br /> rr <br /> lro+A) aLl Li ceAs i 'l (?eetu,i re,vrt exdS <br /> re <br /> e. <br /> a ' u <br /> Date of staff site visit: 12'ZW/ZO�..,,-3 Initials of site visit staff W <br /> LICENSE APPROVED BY .6411/4 - DATE: i 212/ ZDZ..3 r o n 0 <br /> LAND SERVICES OFFICIAL 1.n oo <br /> 0 N., 0 <br /> Page 1 of 3 m s< w <br /> inni <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2022 <br /> r, _J <br />