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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI s r r <br /> Applicant Complete All Sections Below This Line <br /> Original License Fee=$300 Renewal License Fee(Annually)_$150 a <br /> v <br /> Property Owner's Name: Y-Cky-1 n 1N1(:A\ -C T::jGe_ <br /> Property Owner's Mailing Address: I C7I{�� ea1y-10(>_3 L4 -,0 y <br /> �J ,� ` City State Zip U ,� <br /> Property Site Address: ` ID, �t►nbbW L �/t-C� <br /> rG <br /> Applicant's Telephone Number: Co51 - � / — k1�� o r \ <br /> Applicant's Email:**If staff staff has a question about this application,you will be contacted via email. Make sure your email address is K <br /> legible and your email provider <br /> /will accept e1mails from the following address: @BurnettCountyWI.gov <br /> Legal Description of Property: (�U1c�a S�ro�S L0� Z3 ©�'K •11,2_0 tt4j OUJrJ6�-- °r <br /> Section#: 5\(p Town#:T40 N Range#: P(0l W Town of. OaiI <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> o <br /> oc <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> Provide Rental Information � <br /> License Year Applied For: ✓" Amount of Renters Applied For: 1 ° <br /> Local Contact's Name: <br /> Local Contact's Address: <br /> _ZS21 /_ 7� City State Zip N <br /> Local Contacts Telephone Number: 1 J �`V1f x <br /> Most Recent Burnett County License Number: STR- 1 '/ k State License Number: NT(,P'-b5�29 ° <br /> a <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o 0 <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: .� o <br /> Lt C,e�'tS�. -e,X-p I VAS 1 13`12021.p m <br /> ��-�� V2✓�;, -4- nod -}o �K.Le�r� y � � N <br /> to <br /> a � � CA06 ki T k d J3 -7� b-e S�cu rec� m <br /> I9 Le`1 12b25 n Fee Rec: <br /> t I�S� Perm /2026 cl�#: 1�0 <br /> "�he -s1n�d v,�cds a Larld A <br /> m <br /> �I€ <br /> Date of staff site visit: 41 Initials of site visit staff. KC: .4- D9 <br /> 771-1 <br /> LICENSE APPROVED BY DATE: 1-7'2D2_ C-� <br /> r` Ll u u <br /> LAND SERVICES OFFICIAL o o rn <br /> o O <br /> Page 1 of 3 <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2023 r� <br />