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SNORT-TERM RENTAL LICENSE APPLICATION - Burnett County, WI r <br /> cr <br /> a o n <br /> Applicant Complete All Sections Below This Line N. 'AC <br /> Original License Fee= $300 Renewal License Fee (Annually)=$150 I. <br /> o <br /> Property Owner's Name: vu� ��l 2 c <br /> Property Owner's Mailing Address: _ jot) In�e ty'hv-� K-L� J"`A J .� GI v) <br /> ity State Zip '"'3 <br /> Property Site Address: 3/65 �ta,-u- g Of d � J � L o <br /> Applicant's Telephone Number: 5j J' —Si! -d- 5Jb / o r �� h <br /> 1 <br /> CD W <br /> Applicant's Email: ►^\-a v 4 ro ✓4 e wk4 1 Y(. c <br /> **If staff has a question abdut thikapplication,you Will be contacted via email. Make sure your email address is ill 0 <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov P. g <br /> Legal Description of Property: i--csk 1 CSM VV 19i7 L/36 333 <br /> d P <br /> Section#: L3 Town#:_Ktid N Range#: Ji, W Town of: SiA.A`3 5 I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ? -w R <br /> O� <br /> ov <br /> Tax ID#(1-5 digit number;found on tax statement): 3`.id-14, o n o <br /> 5. <br /> Provide Rental Information r. <br /> - '�• <br /> I2 \ N 7 <br /> License Year Applied For: ,�o�� Amount of Renters Applied For: <br /> Local Contact's Name: lraw✓Q raf'ICi I d '0 i. <br /> Local Contact's Address: 85(3- ?7 yit 'w St. Cep _1J( &or 5y0' NI .. <br /> City State Zip <br /> Local Contact's Telephone Number: 6,Jam'/—z�3 3 ''&IJ? 7 <br /> Most Recent Burnett County License Number: STR- State License Number:pimp- 0 5 3SI(p °m v, W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY v v <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: < .3 o W <br /> DLiLerase exores ')3112026 y <br /> OCc man Di avO ad er-hstY"s241.-k- vto4- a-o e x(eel 12 peAf l e. o z <br /> (31 Out- DC Shoes 41) 10.e Y e,mov J or con rvec-te-cl -b --HA Sarni-1-o-fy ie, 1--- <br /> (1S4R--tY\ C' <br /> rn <br /> a,U nt ed s a Lana U s.e P-e + j2o2 <br /> C `�� <br /> CI i t(�1 Ylq r M 1 by ,�( � a Fee Rec:'30/7 <br /> J i Ck#: 1 c7ic," <br /> (.6._,, S4t66 41) ...HA- - fake Nazi a /And Use ( .rien4 by 7ii/9-62yrxi <br /> rn <br /> l/ t2u7 k(,Q 9U,iCloth AIS -b be PDS-61 Du-'Sicik Atar - ke. ►l4ctin uttra.rtce dam'', <br /> Date of staff site visit: 20 1002 q Initials of site visit staff: 1 c <br /> 5II3/202y Q �' <br /> LICENSE APPROVED BY DATE: CDC gs n <br /> <.� Cd�7 v v <br /> LAND SERVICES OFFICIAL CCD CD <br /> U u u <br /> v 0 -n' <br /> N �� <br /> Pagelof3 3 .Nc- <br /> Burnett County, WI Short-Term Rental License Application—Rev 12/2023 0 M <br />