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SHORT-TERM RENTAL LICENSE APPLICATION - Burnett County, WI r <br /> Applicant Complete All Sections Below This Line n el <br /> = <br /> - <br /> o <br /> z C re, <br /> Original License Fee=$300 Renewal License Fee(Annually) $150 2. Z <br /> 1 2 <br /> Property Owner's Name: i <br /> 'n l 'n <br /> Nl <br /> Property Owner's Mailing Address: 2 2j 6 9 g+. ek..,,,,,1 !� ' d1/ lv, ........., con <br /> pp ity < tate Zip �N <br /> Property Site Address:�O I�O 3 �1 l e //'goad ���10(i&j �� 1 jg o - , N <br /> ' Number: " 2 2 _ `t`4 24 U" 1 . J o r, <br /> Applicant's Telephone �¢ Z 1 ., r� 1 <br /> Applicant's Email: y U lw S C a I b del e I I l .i I a-1 / C�vco <br /> **If staff has a question about this application,you will be contac d via email. Make sure your email address is tri o <br /> legible and your email provider will accept emails from the following address: @BurnettCountyW1.gov 2. <br /> Legal Description of Property: rCl/YG.t1 s 6 -6 l Z - Z- - 4-s---(6--(Q Sg <br /> I 1:10( 99°a0 .� / 0l00 to p w <br /> Section#: �� Town#: N Range#: Fj l�' Town a : N <br /> V.l <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* g <br /> rig <br /> Tax ID#(1-5 digit number;found on tax statement): , ° ( N <br /> C U <br /> Provide Rental Information <br /> License Year Applied For: `"'11/ 2 Amount of Renters Applied For: g . v/. <br /> p $ <br /> Local Contact's Name: S c I I NN L c` Vick., <br /> , J �+ r (t a <br /> Local Contact's Address: W L4 IP 010 C D lit 04 1 SSA b030LA- W o <br /> l G CYty State Zip N <br /> Local Contact's Telephone Number: b i — l <br /> Div hT -Most Recent Burnett County License Number: STR- 22.-qt. State License Number: GE 1-_c:.-r 6 ° '', <br /> N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o - N d <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: < -I o <br /> elti(1111-e eVfit(e 1134025 `L; 3 <br /> + no- .tweed o z _c <br /> �C to fan cy arty a ve,✓-�s��rv�e-r� pd <br /> D iiti 10",‘ad)as 413 be PDd o4-siai A - it <br /> rn <br /> nr <br /> V cLoor b...i ID rJ Zb7).1 . See It 4r LLJ rt 44A.e. Li cvm 1 n D Fee Res: d� <br /> 5 Ck#: L e) ,Q <br /> R,ectul rue rye n+S a <br /> Date of staff site visit: df f JI)zOZ21 Initials of site visit staff:<1.- 1 g��,l <br /> ^ 9 �/ ll� <br /> LICENSE APPROVED BY : thtl/n(„a"-- DATE: l I/3/�Zi-1 as �(/��)�< 3 ca.) F+ <br /> CD <br /> LAND SERVICES OFFICIAL A m . na viiii <br /> Oo rn C: <br /> Page l of 3 14.. .- <br /> Burnett County,WI Short-Term Rental License Application-Rev 12/2023 tun, <br />