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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r <br /> CD <br /> ... <br /> Applicant Complete All Sections Below This Line <br /> o' N <br /> ❑ Original License Fee=$300 ❑ Renewal License Fee (Annually) _ $150 a <br /> d � <br /> Property Owner's Name: R 1l I%0 Deaf ri ck A <br /> n <br /> Property Owner's Mailing Address: S(5 S GraYJtWcjc( T ) Ld LC&05se (t it. r lec 0 ) �\ r <br /> �J City State Zip 4 <br /> Property Site Address: 1 l 72 W �di►n d �(�_. �l 54 901 <br /> �" fit <br /> Telephone Number: (PQ99 (D2-q-73.75_ <br /> r <br /> Applicant's Email: p 0j,S IeY ,M du 1. (.awl <br /> g <br /> **If staff has a quest of n about this application,you wil be contacted via email. Make sure your email address is p 0 <br /> legible and your email provider will accept emails from the following address: BumettCoun WI.gov , <br /> L6+ 2 CSAA V n P 232 (#332585) <br /> Legal Description of Property: -r2n V 1 45� <br /> Section#: 25 Town#: 40 N Range#: W Town of: '�C6-1+ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N •� <br /> U <br /> Tax ID#(1-5 digit number;found on tax statement): g�7JT d o <br /> � rn <br /> � C <br /> Provide Rental Information ° <br /> License Year Applied For: Md 5- 67U& Amount of Renters Applied For: (� <br /> �" <br /> _ <br /> Local Contact's Name: is t&46ut r'le I 71 wl,-s <br /> b � <br /> �� n ao <br /> Local Contact's Address: j10 SkV�/Iete� ev"e l-C ��1 Sy�i22 0 <br /> City State Zip w G <br /> Local Contact's Telephone Number: '71 5 - (65 1- 54 S j r' <br /> 2y-2-0 <br /> Most Recent Burnett County License Number: STR- r—" State License Number: ATGI-Q i(q E 7 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r d <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: y o <br /> 2U2(o ' � o CIO � <br /> 2� � avert ad uekhs� nab- lz p�e� ,r- <br /> 5oun��. <br /> 3 hrsu� C�,aarnncst- b rid <br /> t'dk� 4 Fee Rec: J� <br /> da,��' Cejli wwj (, (MS6 r1,,'My erl Sfa.-tt °�-�'of Ck#: I Ui 2 <br /> � � <br /> I,LU,vAAX rt cwn►per � -�plac&" + rt" J , � � <br /> Date of staff site visit: 2'�� Z� Initials of site visit staff: <br /> a-s-aa�s CD <br /> - <br /> LICENSE APPROVED BY DATE: m <br /> Cn 0 -� <br /> LAND SERVICES OFFICIAL o a <br /> Cal <br /> Page 1 of 3 <br /> Burnett County,WI Short-Term Rental License Application—Rev 11/2024 `� <br />