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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI <br /> r <br /> d � A <br /> d <br /> Applicant Complete All Sections Below This Line N• <br /> ah <br /> Original License Fee= $300 Renewal License Fee (Annually) = $150 = a <br /> �1 d <br /> Property Owner's Name: L eeps Fz(L�[{E S ESCz N LLC . <br /> /fin' <br /> Property Owner's Mailing Address: 31 ( _Act�AkW IC n lid CA&A � I` f -SYI zZ rX <br /> i f City State Zip H <br /> p y _ (5 Z --A�tc.� �� �P�tl Bt�..C.y t�17 �yb'30 n 7 <br /> Pro ert Site Address: <br /> < � N <br /> 95Z-3�i � <br /> Applicant's Telephone Number: 7 1 l I L1 <br /> Applicant's Email:, ar(.L— LEA,i tic �� Ae <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is o <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov w CD <br /> Legal Description of Property: C 5 Ip I f V Z t! N SEStiJ / r <br /> Section#: Town#: N Range#: j5 W Town of: __45 Ltd► 5-S (a <br /> N <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> � w <br /> Tax ID#(1-5 digit number;found on tax statement): 5DI to <br /> $ o o <br /> Provide Rental Information C <br /> o � <br /> License Year Applied For: Z o Lq Amount of Renters Applied For: N <br /> w <br /> �-t P�) 12u ff'I <br /> Local Contact's Name: ro <br /> b � <br /> Local Contact's Address: <br /> �_� �I i J <br /> Local Contact's Telephone Number: -7 City State Zip <br /> jY`'f � x � <br /> p GQ- 05 3-" <br /> c � <br /> Most Recent Burnett County License Number:_S - State License Number: L- <br /> 35 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z r x <br /> d d <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: a <br /> dL iCt4,e VYI(eS 113112 z,5 s <br /> �oanG-( a1ci xc <br /> a <br /> o z <br /> g)Sy.Hc �k (I d 40 ward � OL I� Old �l n ► g1 � q w <br /> m <br /> ha4td �uJ&lu% <br /> �,, L�� 1 _ ' p P '�_ / .� Fee Rec: <br /> � `((�YL(R �C�X b I I�Z� . �� eT -/ l�L, rlj �1C�/�cS1171 Ck#: �< � <br /> ./ m <br /> 7y <br /> �U,Ir�1'ri2Y1.tS �C—�� <br /> Date of staff site visit: 11�2� Initials of site visit staff: W� a 3 <br /> 03 <br /> CCD a <br /> S 3 <br /> LICENSE APPROVED BY DATE: 2 mCn <br /> `w N <br /> LAND SERVICES OFFICIAL `Dom c N c� <br /> Page 1 of 3 = 11 LI <br /> Burnett County, WI Short-Term Rental License Application—Rev 12/2023 <br />