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SHORT-TERM RENTAL LICENSE APPLICATION - Burnett County, WI v, <br /> Applicant Complete All Sections Below This Line a p <br /> o. <br /> Original License Fee= 0 4-Renewal License Fee(Annually)=$150 0- <br /> Property Owner's Name: <br /> Property Owner's Mailing Address: ei.l'1, r 5la- <br /> City State Zip 1-3 <br /> Property Site Address: qq3L t °< N <br /> I n/ „ A <br /> Applicant's Telephone Number: �i'j�7L S.� �Il.�r ? r ' <br /> Applicant's Email: bkA Lob told CD <br /> CD <br /> **If staff has a question about this application,you will be contacted via email. a sure your email address is rt o <br /> legible and your email provider will accept emails from the following addresss: @BurnettCountyWl.gov P. g <br /> O. <br /> Legal Description of Property:V"T R& V iP 44. l (. IA/ &W bar z) F, <br /> . , <br /> g �^ Town of: StAASS N o <br /> Section#: �(�G Town#: � N Range#: f Tv <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* g. c- •- <br /> a°o <br /> - c <br /> Tax ID#(1-5 digit number;found on tax statement): 02154(p g y o ' <br /> C <br /> Provide Rental Information <br /> License Year Applied For: 09-� Amount of Renters Applied For: �f -� 1 <br /> Local Contact's Name: > i t Q i i <br /> Local Contact's Address: 3o2...0(o C. 1['©1"J bi lt/5V (c-bl Dgiburpa3� N ICity tate Zip <br /> (1 /5)Local Contact's Telephone Number: -1 3,3 -- i o G �— <br /> � <br /> I <br /> Most Recent Burnett County License Number: STR- Z3- lD t. State License Number:D 6 LC G °m `r' 'J <br /> � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o E Iv o <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: < o <br /> DLxs.e.. okri reS 1 1 3l 2025 ; Z <br /> r _(NC)) <br /> ID B1cLnc ( cvic achiu -/- rO+ 40 -e)cC eeci t rvtl z z ,j, <br /> 0 <br /> bti9a0,,4 lacard by 6 1l ) w2L/ <br /> m 0 <br /> . <br /> 01 Fee Rec: �°� <br /> k1103 .c Liniuiy 2UJ( TPhjJ'7i Ck#: �� <br /> z <br /> F us.o 4' <br /> m t`teC P2 <br /> „ v'tT <br /> � <br /> Date of staff site visit: (1 5 202 Init' Is of site visit staff: T 4- _7 aA�J� <br /> ifio/r. ) <br /> q//2 262g <br /> LICENSE APPROVED BY . WilA, DATE: m 3 <br /> m c D n <br /> LAND SERVICES OFFICIAL <.3 `+' fJ <br /> 2 m ---- <br /> v511 <br /> 0 oa o <br /> Page 1 of 3 N <br /> Burnett County, WI Short-Term Rental License Application—Rev 12/2023 3 <br /> m ffil <br /> z <br /> )) <br />