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SNORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r r <br /> Applicant Complete All Sections Below This Line a <br /> cr <br /> r A. <br /> Original License Fee= $300 Renewal License Fee(Annually) = $150 L <br /> Property Owner's Name: 316 "l ' t S e 6 • a- <br /> Mailing Ave0 -1 !1� 0►'/ vi <br /> PropertyOwner's Address: ` � �vow � � ��3f? <br /> l r� /LLLX � i(Ci t v tity <br /> v Sta_ t�_ Zip < <br /> Property Site Address: / 1(i2 la- EM`(2 6 54 r -t <br /> Applicant's Telephone Number: o <br /> r <br /> • .t 6 <br /> Applicant's Email: bO {[A\e„le tti 62, ci C-C7{ <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is x o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and • <br /> @BumettCountyWl.gov 5• ;1 <br /> Legal Description of Property: 011411 AD 40 J °ICIY7CA1 11 l q d <br /> FD <br /> Section#: 10 Town#: N Range#: t 5 W Town of: C ' � N <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 0° n L <br /> • <br /> tall �Tax ID#(1-5 digit number;found on tax statement): • 4 `'' <br /> =v o lA <br /> Provide Rental Information <br /> License Year Applied For: 1,0�� Amount of Renters Applied For: .5 ,' <br /> Local Contact's Name: ,90tAtl Pt € uv-iu� 1 1• <br /> 77�� /y��(y� r' I z <br /> Local Contact's Address: 2ID ptepsat44-- ave_ a bet wi Lak 0 i 54-�lb o <br /> S's I_�C5-, -7 (-4- City State Zip <br /> Local Contact's Telephone Number: <br /> Most Recent Burnett County License Number: STR- State License Number:NV.)1 -GZ RNwM — 1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: -i ° <br /> f,J LI LL,1& t x ' reS ' 131 (2o2s o -I - <br /> J z <br /> Oc.cupylc i a.✓,,d adv�e%�se=n4Q4+ not 4 p' o <br /> S19-N- 17-2-7clA <br /> -f,�nce <br /> 3 <br /> R 't �,( w� ,(,�h,rs -Iv �e PDS-�d 0 i cp e riea✓ mu'` ri <br /> drerne�r�s <br /> See- IV -, 14) li s,�q �e <br /> �� `6i l [ r Fee Rec:�� <br /> Uc I '_1l p d Ck#: o? 3 <br /> r fan e.i �-e e� a �Al2C� .. st C-e rrn i i' �,,,Irri <br /> y �arQ Shy w Salav`� .� l . <br /> )i(zoz . <br /> y <br /> ' > n <br /> Date of staff site visit: I 25 2.024/ Initials of ite visit staff:T' i o a n <br /> LICENSE APPROVED BY aNC& DATE: 3 (61 Z02 ( �Y- Ind <br /> o c-., <br /> LAND SERVICES OFFICIAL < v ' c <br /> Page 1 of 3 d CD <br /> Burnett County,WI Short-Term Rental License Application-Rev 12/2022 b LQ:=7J <br /> z <br /> m <br /> z <br /> m <br />