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,HORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI ,, r-. t- <br /> • a i; <br /> rD <br /> Applicant Complete All Sections Below This Line N 0 a <br /> )riainal License Fee=$300 Renewal License Fee(Annually)($15j) I <br /> 0 <br /> Property Owner's Name: L ndoY\ .\.e.eorY1,e_, c <br /> �1 1 l �-1I/ 11-� n'��p z <br /> Property Owner's Mailing Address: pa t U m. s t✓1lLMo1�1sIct W 577J <br /> O� 2, 1� City State Zip Property Site Address: Al\d3 CJI Oie. d D K,JI�,�/l�► 1 tT -f-t ,e) IL <br /> �7 �j Q J . O A <br /> kpplicant's Telephone Number: I15 - 2�a 5 -a i S"1 9. , <br /> kpplicant's Email: I ✓\dolnscUizitry Vlore s C rn1a,,1.Coyrl a <br /> *If staff has a question'about this application,you will be contacted via iail. Make sure your email address is rri o <br /> in <br /> egible and your email provider will accept emails from the following address:@BurnettCountyWl.gov <br /> ,egal Description of Property: p YCC,\ OC ‘(xnd I,occOca st v' ame,v✓vvItev4- lot a <br /> ;ection#: '1 Town#: '4 U C N Range#: t4- W Town of: SCO++ N <br /> 0 <br /> `Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> crt <br /> Fax ID#(1-5 digit number;found on tax statement): n-S11- lb <br /> o '4 o <br /> i <br /> Provide Rental Information � , <br /> ,icense Year Applied For: ao aLA- Amount of Renters Applied Fore N <br /> ,ocal Contact's Name: Coup tvtC.tika (1 CrY 1 n,,.,, tom t� <br /> OaI- - <br /> .Deal Contact's Address: 1Le Shbr 0-U Or. Da i ',"^;' �+'T23U o , <br /> City State Zip <br /> .Deal Contact's Telephone Number: -11S -a5�-`-1-7 -13 <br /> 1 D i <br /> Most Recent Burnett County License Number: STR- A-6 - IS State License Number:NG 4 r—biz IL-5F: `,, <br /> a 1 , <br /> REA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o J d <br /> �;� THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 5 o <br /> VGIwi,e expires L /3i/1025 m as <br /> a J <br /> © OCciApanc ! cAd adue14iser Lem4 no-f -1v eYcad �l ►eai q— <br /> Per SAN- 1to -71 o p t <br /> tt9-1-i c -IAA k i i d 4o b.e Secured -IA a lock c .1 n- - M .- <br /> Fee Rec: <br /> r� 64-ita u;�d.e,Q,ias 4 lac i- 0L.-sect k 1°11/Zvztj Ck#: < <br /> Cl <br /> 4 1eU-4 t-�- ork(c l i c-- Yw-hiae r �/ <br /> )ate of staff site visit: I jt 0 p (2o2L/ Initials of site visit staff:`�i"` . J <br /> q <br /> ,ICENSE APPROVED BY DATE: ! Ji ( /zzj Q Jul <br /> AND SERVICES OFFICIAL m c� <br /> < 3 —._ Innf <br /> N ( L l i l l <br /> 'age 1 of 3 m 0 0 0 <br /> 3urnett County,WI Short-Term Rental License Application—Rev 12/2023 (D C E.�.` . cc <br /> K <br /> a 1,.L JJ <br />