Laserfiche WebLink
SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r r <br /> c ro <br /> Applicant Complete All Sections Below This Line <br /> ,Original License Fee= $300 Renewal License Fee (Annually)=$150 . <br /> il() C&W it / 1 a-6) lam//' k E PropertyOwner's Name: r <br /> /�3'1 S► 9 <br /> Property Owner's Mailing Address: � �1 v � q v� <br /> P Y 02#3g (Alai 1) I v:c. 1 d,n, 2U City CALL- 6te �j �-'u d� "�Pro ert Site Address: Ti.-1c> ' <br /> 4. <br /> Applicant's Telephone Number: 5�5� ",L;P r ° r 1 <br /> Applicant's Email: Qi �in ee re Wte ), a <br /> If staff has a question about his app ation,y �Gvill be contac via email. Make sure your email address is Cr <br /> o <br /> legible and your email provider will accept <br /> ^emails from the//following address: @BurnettCountyWl.gov /` a <br /> Legal Description of Property: (// ' D3pc"��Cif /e5 a , 05' 0 5- Q ls6v' c <br /> F.? n <br /> S tir 5S r <br /> Section#: a Town#: N Range#: 45 W Town of: N ", <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* . r <br /> Tax ID#(1-5 digit number;found on tax statement): 3.5 / I Q n E-; §-A <br /> Provide Rental Information '7 ...° �' <br /> u �Cl <br /> License Year Applied For: d Q� / Amount of Renters Applied For: J 1 9_ <br /> Local Contact's Name: AA e c6!z l re, b g. <br /> . E <br /> Local Contact's Address: 2l/'( ,g2xoir& ,& . `// ,Lei(1 X/ t/7 L? ?O o <br /> City U State ip <br /> Local Contact's Telephone Number: a/9" 01 oc 9 — ?c9c26 <br /> Most Recent Burnett County License Number: STR- State License Number:C ZA1,4 -AZELCL ! <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 6 ler, Ili <br /> 5 <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: S <br /> D LiCCAS-e. t)CO(CS 1130023 n <br /> 0 Dccu po r OAd adve.r+iSui .e n,+ no+ o ,exc e.e,ci Li Lt per SIN4 a z <br /> r c!,,.) <br /> 117g3 — <br /> 10l$� . {tad yt,.‘altAliSby 4[1 (22L1 .20211 0Q4anoi aild couati Iiu r►c-e ils <br /> harm,( _ G <br /> Fee Rec 3L <br /> Ck#:j 79D <br /> z <br /> rz <br /> a <br /> ' -4 L.JJ <br /> / - w <br /> llill <br /> Date of staff site visit: Initials of site visit staff: ' 4' GIL °0 3y�s12LI � � D 0 <br /> / m CD <br /> LICENSE APPROVED BY . Allie;t( DATE: Lr (� y o c o <br /> LAND SERVICES OFFICIAL R. cm ‹. <br /> 3 "� <br /> CDuuv <br /> 7 <br /> Page 1 of 3 — (� _ J <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2023 <br />