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SHORT-TERM RENTAL LICENSE APPLICATION - Burnett County, WI �n r r <br /> a. <br /> ... <br /> Applicant Complete All Sections Below This Line M a <br /> R <br /> rA <br /> 0 Oritzinal License Fee= $300 0 Renewal License Fee (Annually)_$150 <br /> ;;�� <br /> n -4 e <br /> Property Owner's Name:R t c4 U r^(,'J I O�.f�'1/,l �i'�'S4 j-P g O-5-5 o t2J <br /> A <br /> Property Owner's Mailing Address: , 1 S-er l—,, S`19-93 <br /> � n City State Zip <br /> Property Site Address: �rj �7 �c� e �){,1�S r Lv, 5'9 c 93 o G ni <br /> Applicant's Telephone Number: 7/ 6(p - / 6 <br /> r <br /> Applicant's Email: r P .f-e-C f ; s b/ Ct) ✓1/1 u i C G YY� o <br /> **lf staff has a question about this application,you will be contacted via email. Make sure your email address is o <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov <br /> Legal Description of Property: C-C ✓ L-tt J to a <br /> Section#: Town#:_4/0 N Range#: / S W Town of: c k -5 0 n <br /> N <br /> *attach additional gage if needed for lengthv description OR attach a colry of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): S?j --7 t-:�, g n c <br /> Provide Rental Information o <br /> License Year Applied For: 0 Amount of Renters Applied For: Ar <br /> Local Contact's Name: ct.rCJ [�Osso(,C) II <br /> Local Contact's Address: <br /> City State Zip <br /> Local Contact's Telephone Number: <br /> ! 7-4P- 0 t.Z7 6 4S -Q C <br /> Most Recent Burnett County License Number:YSTR- 9.`'/ ^ f State License Number: <br /> z oQ <br /> AREA BELOW 'TH1S LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS COMMENTS/CONDITIONS ONLY c � <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 2 0 CF,1J Q h a,v�d a.d no+ �o �t.cceed �4 I C � � s <br /> O p � �� <br /> o <br /> 3 Utr� b be, o pev-&*td o.S ot.. motf-I b+b/ U_)C4f10l A* tx, rf-Zzn L. m <br /> `thlS iS0, iVVjle,po- vL11� dt O-ainj , co <br /> _ <br /> Fee Rec: <br /> �1 S SeCu red i 4 h 4l, Lo ram- cvt�,i �y I�'►125 ck#: ! <br /> •Q,�h v+a+n l� l I � b� <br /> Pl acoxd r��,ct..� lrn a►� 2,v� �dfsnr tD be Pd u511�1�i Cu rvevlt <br /> C'tjuvti Li C�S� t�u vnber b vJ (Q� j 2 5'. <br /> Date of staff site visit: 2 Initials of site visit staff: �--i� 1�-vl ,- �.•--- �-�} <br /> LICENSE APPROVED BY DATE: -�t�'Z�ZS CCD <br /> LAND SERVICES OFFICIAL N <br /> Cl) <br /> � <br /> 0 <br /> N <br /> Page 1 of 3 <br /> Burnett County,WI Short-Term Rental License Application—Rev 11/2024 m J� <br />