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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r <br /> cr c A <br /> et CD <br /> Applicant Complete All Sections Below This Line N N y <br /> o <br /> c <br /> Original License Fee= $300 Renewal License Fee(Annually)=$150 a <br /> Property Owner's Name: AAdne, Zw(.co.tt`` 7 <br /> Property Owner's Mailing Address: i'Fi <br /> SC �3 Ec;c ILSor -\14 JAoUN S \\:t iS IAA) 5SIVL City 'Statj <br /> a Property Site Address: 3o2'Ha 1ST ve- e i�� W3 ''"ldApplicant's Telephone Number: (Q J i — 67 S — '7 / 'O g ' <br /> --•----�� 0 Ut <br /> Applicant's Email: Z.�cc o,,cc4 ;pr o/Q v.%0.1 I - (owlrD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is Crl0 <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov ,' <br /> Legal Description of Property: <br /> Loa - GSA 52 N Vol_ 3o P WC•DX,• If 81 C.1 c r <br /> 6. i.. <br /> Section#: i?� Town#: N Range#: W Town of: 5�` S N �' <br /> *Attach additional page if needed forlengthy description OR attach a copy of the deed OR attach tax system property page.* I. w <br /> Tax ID#(1-5 digit number;found on tax statement): 3(.96 I R a n N <br /> o E <br /> Provide Rental Information <br /> W <br /> License Year Applied For: 20 Z� - 2'S Amount of Renters Applied For: �' <br /> q <br /> b <br /> wf� <br /> Local Contact's Name: 14 4. y�CtP��� r <br /> Local Contact's Address: 3110 cf(o L �d �6,NA y wI J lig30 — 0 <br /> / City State Zip <br /> Local Contact's Telephone Number: G(.31 `l B 5 S Ly 1 <br /> Most Recent Burnett County License Number: STR- �l . State License Number:aTF- 933 d `n <br /> a x <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY u d <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: H W <br /> rri w UN <br /> 0 iS lOcct,Aion ha a publl c swke,f. bccu,frncy r-v..m -f o z <br /> 40 c ee ck yak Conde-li t.elS <br /> rn <br /> Di Ftb(A) COI l,iuL.nS1n1 Relu,i(e► -n ` - 2� � <br /> rn <br /> 0 <br /> Fee Rec:�C a17522 <br /> Ck#: 5v(( <br /> a <br /> m <br /> to <br /> to <br /> l J <br /> re v <br /> Date of staff site visit: 51�`/Z� Initials of site visit staff: VT' `'f`. Q <br /> co IG�NV"� m cDATE:5 021/ CD CD ��,nI <br /> LICENSE APPROVED BY m `= �s u i Ll <br /> �' C) rn <br /> LAND SERVICES OFFICIAL 0 crs <br /> B [Fa <br /> Pagelof3 CD u <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2023 J <br />