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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r r-, <br /> .. <br /> cr <br /> Applicant Complete All Sections Below This Line <br /> o' `n <br /> Original License Fee= $300 Renewal License Fee(Annually)= $150 a <br /> Property Owner's Name: 1 E t'S '"`6(Z f l E S ESCO N L-LL • a' <br /> A <br /> Property Owner's Mailing Address: SID I E i•-A�• -M IC 64.4 Alt)Ss(z z . <br /> / � ' I \ City State Z. y y <br /> Property Site Address: to 6(�f 2 �—p"«- 2t RI u(kt� Btn,<_ (IT Sy 30 o <br /> �5Z-3 5i �7 L�Applicant's Telephone Number: �� I r i o t- <br /> Applicant's Email: kj, C(,-r))�h 6 Ite.c: ktUII u /e , 6, <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is x 0 <br /> legible and your email provider will accept emails fromthe following address: @BurnettCountyWl.gov P.• <br /> Legal Description of Property: C V"4 d,( 1 y/3 ?i-e 2 (1tg 5ESLA.) ) t- ' <br /> o C ` <br /> Section#: 1 9 Town#: g i N Range#: i5 W Town of: S LJ► S_S V la <br /> N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 4 <br /> Tax ID#(1-5 digit number;found on tax statement): 2 15D a o C N <br /> g. u <br /> Provide Rental Information <br /> Ce <br /> License Year Applied For: L' Amount of Renters Applied For: 0 .. <br /> l N <br /> Local Contact's Name: C�AL u 1f I' I <br /> '/ n j I b � <br /> Local Contact's Address: 6041`y At 1/v L4 L6 /?J • 1 Jesr2 L 1 99 3 m z a <br /> /� ��77 ��i City State Zip Gf- 053�oy � Q <br /> Local Contact's Telephone Number: —I5L'�e /-7 `'1 ` J <br /> Most Recent Burnett County License Number:_S State License Number I-CE5 � ° - 1 <br /> z - <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY d El- <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ,, o �, <br /> dLic e. �X•pilees ' /3i1ZD25 F s o <br /> -hse-►-rt.e n of- -Po xc ee l Coy <br /> Occ u,e0,,nG-/ cnd a -c' P�� <br /> > <br /> ! <br /> C -I-MIL lk ( 'ICI 41D 19.e YtC[,►-1'f d tt-e-i'k a Iv/ aid cJ ct ►'-1 j g `202L1 w <br /> tr <br /> rri <br /> n.�I.�,, o JJ ,,, pp ((�n <br /> 10 ' - Wl 1,1;10 �•�l NA �S °Uhl-fiLe neo-►' `� al ,c n Fee Rec:3(�C3 ' <br /> P <br /> n.(x. 44, r by 81301ZDzq . See l c,-H-cr LL) q Lice/Is/1x Ck#: t l�3 <br /> In <br /> r — <br /> m <br /> ffil <br /> Date of staff site visit: (411/24 Initials of site visit staff: & iti n m <br /> mc� DG <br /> LICENSE APPROVED BY (�DATE: �� �G� N Ind <br /> v, 0 Co 0 <br /> LAND SERVICES OFFICIAL Co N C3 <br /> w`< N <br /> 3Mil <br /> Page 1 of 3 co <br /> Burnett County, WI Short-Term Rental License Application—Rev 12/2023 2) <br />