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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI v to <br /> • Applicant Complete All Sections Below This Line 5• a y <br /> Original License Fee= $300 Renewal License Fee (Annuall = 150 n a <br /> / d B <br /> Property Owner's Name: cr <br /> Property Owner's Mailing Address: /,/67, 7:-C y / ut ril <br /> ty torte Zip 7yd <br /> Property Site Address: ' Pi./ T 7 o 0 <br /> C � � <br /> Ste <br /> Applicant's Telephone Number: _F/4 / o 2- r —. <br /> p,7--, ( A . I l �/ LbY 7i/4/6/ //Applicant's Email: -ti f Lam` <br /> **If staff has a question about this application,you w e contacted via email. Make sure your email address is t 0 <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov / � T. 5.11 <br /> r 'o' <br /> Legal Description of Property:Lo4- l CS an V[-i P 151 (0,3z3 2-3-0 (67Dv 3) 3 Sous( o ° ;6 <br /> Section#: 3 Town#: 3 j N Range#: /K W Town of: ,�G( 4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* g. w <br /> Tax ID#(1-5 digit number; found on tax statement): S 2-- eg <br /> o <br /> k. UN r <br /> Provide Rental Information ° r <br /> 74 Cl) <br /> License Year Applied For: 2 Amount of Renters Applied F : N <br /> Local Contact's Name: /4)/Ar ,2; i lJ S`Gm <br /> oa <br /> Local Contact's Address: v22 � 41y /�Pf`l � /S%�� _ ° '.` <br /> ` v City State Zip ON IN) <br /> Local Contact's Telephone Number: ?/f —$ Z 0 — S 3/ ,.0 <br /> Most Recent Burnett County License Number: STR-22.- 01 State License Number/Vag J 6P n, a Cl) s <br /> -a <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY c W d <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: < .3 o <br /> o L'(Li1 -€ tkpi(CS ' I$ Jz 25 P. .,,, g 0\ <br /> -I __D flc <br /> 0DCu,Pauiuy cod ativt.r+�S-e.r►tk,rvi- no+ -b .ex.ce.e.d q pe-o'Lk- ., <br /> z -J <br /> ID Lock 04d r,!'ic60 rl.kukcl 04 --NAe Ser- c —ank lid by le 1112DM — <br /> 136;VI-Eat - <br /> b I�,c foS.�e�l v��Side r r►�p%�n5wap,lim <br /> d <br /> �� a Fee Rec:3Q(>°� <br /> olaor 19-1 tell c,,,,K ( (L l rt� tair` . Ck#: / r <br /> x <br /> m <br /> tn <br /> rco - <br /> Date of staff site visit: I 130/2. zt.i Initials of site visit staff: CO <br /> D <br /> 2 <br /> <,3 Z <br /> LICENSE APPROVED BY C?dtatio —7G��' SZ0Z�(DATE: C µ '� Inn <br /> LAND SERVICES OFFICIAL CD 0 iv <br /> N <br /> Inn <br /> Page 1 of 3 . <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2023 J <br />