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"SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r r <br /> Applicant Complete All Sections Below This Line y <br /> Renewal License Fee (Annually) _ $150 a <br /> 0 Original License Fee=$300 � <br /> v <br /> Property Owner's Name DFvx l`Se1L �S I T JQ 5 t�f-5 LLL �' <br /> Property YOwner's Mailing Address: <br /> City State Zip ,gyp <br /> Property Site Address: 2 2�`l`1It- ff-4--r15 C lg - Lr-k-- ,-�I L,-" 1r� U�i `�`��'�O S L ' <br /> P ` N <br /> Applicant's Telephone Number: to 1 a-9(0 7-B S r1 <br /> ` _I L L l � bC l 9. G�r �• 9 <br /> CD <br /> Applicant's Email: {� a CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is S x <br /> legible and your email provider will accept emails from the following address: @BurnettCountyM.gov <br /> Legal Description of Property: p{'fZi CJ7-�J <br /> Section#: 0 1 Town#: 1+0 N Range#: I LA- W Town of: <br /> N <br /> *Attach additional a e i needed or len th descri tion OR attach a co o the deed OR attach tax stem roe a e. <br /> P 8 .f• f g Y P PY .f system P P rh'P 8 �• C <br /> w <br /> OQ <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> C <br /> Provide Rental Information ° <br /> -d cn <br /> License Year Applied For: a D a S Amount of Renters Applied For: y" e-�j2 le, <br /> b <br /> Local Contact's Name: L <br /> Local Contact's Address:(0 9-5 6 F,ocr-,o Sze C a c L) h5 r tx-�� 42 9 3 0 <br /> _ City State Zip <br /> Local Contact's Telephone Number: <br /> C c <br /> Most Recent Burnett County License Number: STR- at I--If-a State License Number:Pf-GP-05 q-t 9`( M <br /> a J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENIVCONDITIONS ONLY d <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: a <br /> 0 Li r✓e� �y�t r�s I-31-2-�� -� -S' <br /> a n L <br /> 22tj3� <br /> A <br /> � C4111-t <br /> u L c-'v► �l D Fee Rec: — <br /> L� e n u Inn r b 5-l - 2v 2S. ck#: <br /> 0 I i au L iC, a Si vj� red <br /> Date of staff site visit: Initials of site visit staff: L(3 4- <br /> Q <br /> a��g-a��s �W > � <br /> LICENSE APPROVED BY DATE: <.CD <br /> = z <br /> m —► <br /> LAND SERVICES OFFICIAL p on w o <br /> C= <br /> Page 1 of 3 C <br /> Burnett County,WI Short-Term Rental License Application—Rev 11l2024 <br />