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• <br /> SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI 7cr <br /> Applicant Complete All Sections Below This Line <br /> c' <br /> Original License Fee=$300 Renewal License Fee(Annually)=$150 a z <br /> c <br /> C ( � � _` ° c <br /> Property Owner's Name: �JG.YiC'f�r'1O . \ ��'` V F, <br /> \\\ \��. \_se <br /> Property Owner's Mailing Address: `�, � _ ��e ,S5\L"i et <br /> c, cA <br /> 1�- \ke d �Ld. \N 460&lt.-li \NSy t SLkak 1 S <br /> PropertySite Address: <br /> l <1.� N <br /> ei k 2-`k so —� Q S� r „�C A <br /> Applicant's Telephone Number: o <br /> r (1 <br /> �7�, <br /> Applicant's Email: So. 0 .— O\ S Qo.VA\( �\�` <br /> Y (V\GU\,CA n/1 \ <br /> **If staff has a question about this aprtrcation,you will be contacted via ema 1. Make sure your email address is x o <br /> legible and your email provider will accept emails from the following address:@BurnettCountyWI.gov - <br /> Legal Description of Property: PG L Nw SE o <br /> 2 �, A o <br /> Section#: Town#: J� N Range#: \� W Town of: \v`Q�.Vvp V-1 <br /> o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> o w <br /> Tax ID#(1-5 digit number;found on tax statement): \ 2- OZg o n c <br /> N <br /> U <br /> Provide Rental Information I., .2- <br /> License Year Applied For: <br /> 2-'0�'1 Amount of Renters Applied For: <br /> Local Contact's Name: `C\eQ` 1e . A.Nc8'..c,\.1- 1 ro <br /> b <br /> Local Contact's Address: 21 33 2 1O b �(�. .CAII3i C., s DWI £ LQ12,41 1 o <br /> City State Zip 10 A.tic <br /> Local Contact's Telephone Number: k-Q-\Z— S1 5 — \ S 301 <br /> Most Recent Burnett County License Number:_STR-Z2.i \ State License Number:S Lv'A� ° j <br /> 7.AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Z jS x <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: '_ - I� <br /> ØLc. rt. e x.p i reS t 131 (2 T <br /> 025 3 0 <br /> Doc,,,,,.,,,,,./ e t ) aciVe,1-h's€-► ,-/- no-f- -¢o -CX,c-d u �h2- fOQ <br /> CD 6u.n,k.k LA Ca.riab* fie. reA-k-1 12e r -NAI 6'4.n k,cause a5(. -141P- �+ z <br /> z i� <br /> yki‘A s k dR b y I i Ong f p< I <br /> m <br /> /�° <br /> `�'�-� CO1,�� � ��5'3'l '`ZI�. � Fee Rec: <br /> ram,,-_ co .{� l i c e n.s-e. 4 - aAul --Nkt COxl,v� 5 Ck#: 5 a 3 <br /> Date of staff site visit: 1 9 I ZDZJ Initials of site visit staff:,s --r— <br /> LICENSE APPROVED BY DATE: 1 I ID'Zp2y rco <br /> Q. �. <br /> LAND SERVICES OFFICIAL W co <br /> C D <br /> Z3 Z <br /> m c. (= c <br /> Page 1 of 3 Q 0 N <br /> Burnett County, WI Short-Term Rental License Application—Rev 12/2023 w ,i <br /> m M <br /> 7 i <br />