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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI <br /> r, <br /> Applicant Complete All Sections Below This Line <br /> ❑ Original License Fee=$300 "enewal License Fee (Annually)_$150 a = <br /> d <br /> Property Owner's Name: MCC /3 rYJ/4'/ Q�(, 1-,4/(E L LC <br /> Property Owner's Mailing Address: ER iq V C# E3 7Et47-0ti /r(/ `4 30`' � <br /> City State Zip "1 <br /> Property Site Address: �99 L,!�}/(LDS DR 1 UE D H NBu R y, l.tJl s� 3� � <br /> °< N <br /> Applicant's Telephone Number:7`HOrn,4 S I?r-C- c.l A IP 2_19-Z/ y-6 7,573 r <br /> o r. <br /> Applicant's Email 4,7 6 t! ��C girWCL t c O.-n <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is M C <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov <br /> ,gEGOR.De-a ff-S \ <br /> Legal Description of Property: LOTC 5M 5-078 voL AgfO DocCt► F,--T YMo ( 3) <br /> � ' <br /> d <br /> Section#: X& Town#: W N Range#:ISW Town of: s!..-j/SS <br /> N <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of'the deed OR attach tar system property page.* ? <br /> o Tax ID#(1-5 digit number;found on tax statement): .3 sO 7 <br /> T <br /> Provide Rental Information ° <br /> License Year Applied For: D.2 S Amount of Renters Applied For: e N ° <br /> i o0 � <br /> Local Contact's Name: J'H.-!e= M C 6 U_-r/Z E <br /> Local Contact's Address: 30/68 COM ivT Y R, 1>6 ru80-A Y, W.l <br /> City State Zip <br /> Local Contact's Telephone Number: -I,)_q <br /> A-TCP-Ofq(OZ9 <br /> Most Recent Burnett County License Number: STR- State License Number:lBf'dI Tom! ° v' N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o x <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Ln <br /> .mac <br /> m <br /> a <br /> OCGu,pah -� ad�e,�rh�-rnev��- r,a+- +,� �accee� $ P� z z <br /> m <br /> 3 2oZS u <br /> CP <br /> �T I,ccevls�at� rev�-u-I a cdel�►�es I . �1 <br /> Fee Rec:_L..1� <br /> vh - ✓n CDU I�Ca,c �dt � 6v� C� Ck#: ()bb77 <br /> WV , m <br /> a <br /> m <br /> Q �i <br /> Date of staff site visit: '.2Z- Initials of site visit staff: Lg + KG <br /> CD C CnW <br /> LICENSE APPROVED BY V, DATE: 13 M ��7 <br /> LAND SERVICES OFFICIAL N n IJ u U <br /> CD a o <br /> cm <br /> Page 1 of 3CD <br /> Burnett County, WI Short-Term Rental License Application—Rev 11/2024 <br />