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cn r <br /> a 8 r" <br /> aCD fa <br /> SHORT-TERM RENTAL LICENSE APPLICATION—Burnett County, WI N: ° = <br /> cir CA <br /> Applicant Complete All Sections Below This Line p n. <br /> d � <br /> El <br /> Original License Fee= $300 Renewal License Fee (Annu. IT) = $150 v 1' <br /> )01 <br /> Property Owner's Name: ... a 1 �n , Q, Y t( S to <br /> � y <br /> Property Owner's Mailing Address: 8 I$ 1-1 Q G,00 T lA S-- (K,1 i c$1l7 if. 0 <br /> (� �J City State Zip 11 r <br /> Property Site Address: 95Cf ') J o��,�_ �-.d-- Dr ,y e I Dr.- rp:,/,- 1 iAli 5 6173 O ° �. <br /> it Applicant's Telephone Number:(6 ill) Z 3-1 - S1 62 <br /> x I <br /> Applicant's Email: 5r r\ 1 _ -P,,,,,,i v �- 1 @ n <br /> Legal Description of Property: L ak 5 C S (✓i 1 14 P ZLi C (0- 6 l -.6Section#: S 2 l Town#: 'ri-i 6 N Range#: is I_7 W Town of: 0nj",„,-, N lr �i <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o0 <br /> in v; o Ilk <br /> Tax ID#(1-5 digit number; found on tax statement): 2-5 b 1 Z N <br /> o < 00 <br /> Provide Rental Information w <br /> License Year Applied For: 2 0 Z LI Amount of Renters Applied For: - - <br /> Local Contact's Name: LO n 8,‘ No I <br /> z <br /> Local Contact's Address: Zti G e(7 ca..4,4,V .`s,.„- )( 51.41) LAtee, (Ji1 57! °- <br /> 0 ` <br /> City State Zip oQ <br /> Local Contact's Telephone Number: (i l 5) 5 w - W C f p �,o <br /> ....D <br /> Most Recent Burnett County License Number: ��STR- 23- b I State License Number: t>✓, C14 Z`,7 G w \ <br /> ..0 d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> 0 Lict,nse e pi(�S t I o G <br /> and ad v r-1� 4- n°4- - o "tyee d l e z N <br /> ZD c�,upr�n a e z <br /> Plc rd k Vie- u pd.r ,-kd -1 l occd c ort+a(4-, coup-Fi coy4-0-uf g <br /> a,nd 1 i ULASt ALthrtibe,r b'`i 6f 1120Vi o lb <br /> ;� Fee Rec j'DO <br /> J RitIuw ct Ci CQ4€' n9 f r.+,►r'e-wl,p ri- 8 Ck#9•D/3c) <br /> Date of staff site visit: 2`2o'Za2y —( <br /> Initials of site visit staff: 5g <br /> Co <br /> LICENSE APPROVED BY g4DATE: Z 20Z y Co l J <br /> -n r- <br /> LAND SERVICES OFFICIAL o Co -n <br /> o W1 <br /> QOn CC Uu , <br /> C7 IV <br /> Page lof3 Co �� r <br /> Burnett County, WI Short-Term Rental License Application—Rev 03-2022 <br /> mum <br /> L� -2J <br /> rn <br />