Laserfiche WebLink
SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r <br /> CD A <br /> Applicant Complete All Sections Below This Line <br /> = c e ID <br /> Original License Fee=$300 Renewal License Fee(Annually)=$150 a <br /> d E <br /> Property Owner's Name: (r y La r5CJn s c <br /> Property Owner's Mailing Address: 0':a 5 9-0'n'1 Ave- Wi. M,✓1'imp o i i"> ;1 <br /> /V1N S�S�II� � v, <br /> oZ'8 S (o k 1 /kare fed , 0G446ory City y8•-.3c.)St Zip o 1-3 <br /> Property Site Address: � (rV Z S " �G, � , <br /> o N <br /> Applicant's Telephone Number: (.P(3-3-0 I -y"j 3, o <br /> Applicant's Email: C D ry I U r9..o S 9 Mot C'OK" <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is o <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov <br /> 1. q <br /> Leal Description of Property: Eli h�e€/1� &eel 61 j(j 4.yi . Let ►a o <br /> g P P rtY V��lGt�er V;fIAL d (� <br /> / v , <br /> Section#: 01 Town#: D N Range#: /y W Town of: COf'� ,_ <br /> N <br /> o N r ry <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): I 1 31$ r n N <br /> a. E o 1 <br /> o I <br /> Provide Rental Information '"0 <br /> cr <br /> License Year Applied For: (p�.0 � Amount of Renters Applied For: O <br /> Local Contact's Name: '`obL La r se)n 0 <br /> � nn <br /> Local Contact's Address: 3.1I/V ) 6l l' / W,/ Ci rc f e p6o6vey (i Z s-yvo o <br /> City State Zip <br /> Local Contact's Telephone Number: -P(a-a(.04_ 5`3 5 if O <br /> Most Recent Burnett County License Number: STR- State License Number: IV Wo n- C XNT ii u ' <br /> l; <br /> D 0 k <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 6 .J o <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: < H o <br /> Obcenct. drir?eS 1I31I2o2cp w <br /> cn <br /> ;0- <br /> O DcLuf anu 0A,&F advtr-i-is .n-F no-i -ap -e acted (k pe o pi e z + <br /> © g 6146 ' ()Cl cUi at -o lie Posia Ouh>' rnu tin -e.n- ntc .-:c <br /> k b'-1 Iv 11 )202'-L S-ee le+-f-e r (L") q Lic sina) R.ectu,+r-eml-t 1 0 <br /> Fee Re <br /> I� -1 Ck#: �D 7 <br /> 10e1-1'iC S S- .m ►S GLe JD 12e 5e f-v a,d x <br /> m <br /> Date of staff site visit: , 126 GK r J L )% <br /> 1 Z�-1 Initials of site visit staff: T r- <br /> w <br /> Il ll <br /> , <br /> LICENSE APPROVED BY DATE: �1 (�f fa. <br /> (�,r1 <br /> m W <br /> LAND SERVICES OFFICIAL <br /> Page 1 of 3 i,‹ <br /> ' � <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2023 B <br /> L- )iJ <br />