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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r <br /> g � r <br /> Applicant Complete All Sections Below This Line N <br /> c A <br /> ❑ Orip-inal License Fee=$300 ErRenewal License Fee (Annually)_$150 a <br /> 1 d <br /> Property Owner's Name: LlA1nd oy, defcnn-c- <br /> Property Owner's Mailing Address: C M � <br /> n City State Zip ' 3 <br /> Property Site Address: o� I �o?.tG �o0t01 �ItlYlt lt.7Z 53b <br /> Applicant's Telephone Number: <br /> Applicant's Email: kMM W 5 QA S+orn 00M f.S ! iroq 1 I ury) <br /> **If staff has a questioiYabout this application,you will be contacted via email. Make sure your email address is K <br /> legible and your email provider will accept emails from the following address:@BurnettCountyWI.gov <br /> Legal Description of Property: lY l o�land locakd in ✓Y1 } A � <br /> Section#; ok Town#:__��N Range#: W Town o : S Co N <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> 5 <br /> Tax ID#(1-5 digit number;found on tax statement): 1"I$(� a o <br /> rn <br /> Provide Rental Information <br /> C <br /> License Year Applied For: Rog2 S Amount of Renters Applied For: <br /> AA,A�'_AAII <br /> Local Contact's Name: �l�M ,vK:.�v\ak1 0-✓) <br /> ao . <br /> Local Contact's Address: a0�01 LR I SyInu✓ l by". W-1P 9 50 c <br /> City State Zip C1� <br /> Local Contact's Telephone Number:--Its -a !9 -17 16 �o5 Zip <br /> z <br /> ua <br /> Most Recent Burnett County License Number: STR- 0 14 -Q1 State License Number. 6' <br /> t <br /> Aftk QW_=R i.INE;FAR Ll1141D SERVICES ATAIN'l~ I141IEN'TS/CONDiT10NS ONLY C7 <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> Cl) LCe,,Se, 1�eS 1-31-2o2(n. <br /> LICt-v� 11u,wlber (x, fott, L�cGv►5a, lnttw ber b 5-IS-2025-- <br /> ' <br /> 3 �iU be re^0ve,./abavP ahao) or PerMT1, 10t3 7-1-Ulq, <br /> Fee Rec:�� <br /> Ck#: C/,6L <br /> O �ll t� a,u- l.lcev)�lr►� r �w�e�• r <br /> Date of staff site visit: -Z�-2�� Initials of site visit staff: <br /> r <br /> LICENSE APPROVED BY DATE: -`7' n s` M <br /> CW 0 <br /> LAND SERVICES OFFICIAL �_ 3 a. <br /> CD = r%j <br /> cn0 <br /> Page 1 of 3 �a o <br /> Burnett County,WI Short-Term Rental License Application—Rev 11/2024 <br /> CD M <br />