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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI c. r <br /> c 8 r <br /> Applicant Complete All Sections Below This Line y- CD n <br /> g <br /> Original License Fee= $300 Renewal License Fee(Annually) =$150 a <br /> Property Owner's Name: ,%jd� 'r2) 2 d <br /> Q,L M2C ' h . cr <br /> 9 <br /> Property Owner's Mailing Address: 765 -"" `id/7 Zde s4r4J/5J 6e �" y <br /> f 1 City ate Zip ' <br /> Property Site Address: �(� yie✓ / o <br /> •ry �y < <br /> Applicant's Telephone Number: // '"79, 4-143'9 0 <br /> Applicant's Email: 4G4 L41,„e/''e42'GZ24)I eJj,9Q j/L e.,~ <br /> **If staff has a question about this application,you will be coht cted via email. Make sure your email address is tr 0 <br /> legible and your email provider will accept emails from the following address:@BurnettCountyWl.gov w. 0 <br /> r a. <br /> Legal Description of Property: o <br /> d <br /> Section#: 28 Town#: 4' AJN Range#: /4,I/A W Town of:1)41 N <br /> o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ❑ .- <br /> ao <br /> w <br /> Tax ID#(1-5 digit number;found on tax statement): /37 ,5" q IA o r- <br /> _4 4 U A <br /> Provide Rental Information <br /> ova a-- <br /> License Year Applied For: 21 Amount of Renters Applied For: E'3 f <br /> Local Contact's Name: 4/IZi t- ,Ce 'z&4 <br /> ��yy n ll ,.r /� L- • ro g <br /> Local Contact's Address: 7L156 dl1/2 �ptt.( � of al/ 9. °O o . <br /> City State Zip c 9, <br /> Local Contact's Telephone Number: 7/5 790- 743 9 ,,,, Z1 <br /> Most Recent Burnett County License Number: STR- State License Number:4 i -o138oS ° - <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o c,G c d <br /> `THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: < y o <br /> — 1 l 4 ki 1 l p% )1.� :jnm c .-.1 <br /> Imo- ��l ��r S � � <br /> 0 o.,n Iv* e w�.e 9. "l, Rt°e�' RC..- l�tb ) z E <br /> -o fd. War roc, �J w& f tea. ( ka0 ,. two.), c�u: ,s,, 41�"c <br /> s C 6" <br /> Sete, 1 CL) o-� 1,�ewrsJ .- ">„ <br /> r <br /> 4 Fee Rec: b <br /> b Ck#: hc7,75.. <br /> x <br /> ra <br /> x <br /> m <br /> r <br /> Date of staff site visit: y 1ti1 iVA Initials of site visit staff: G� --J <br /> r <br /> a) <br /> LICENSE APPROVED BY : DATE: -7/5J !r7 W M�� <br /> LAND SERVICES OFFICIAL 0 CD <br /> `•z <br /> ccg c) N.: E <br /> a o o <br /> Page 1 of 3 <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2023 3 "�" <br /> n <br />