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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County WICD <br /> r r <br /> Applicant Complete All Sections Below This Line <br /> _❑ Original License Fee=$300 Er Renewal License Fee (Annually)_$150 C Z <br /> a <br /> o � <br /> Property Owner's Name: 4;/4 4 ycL4—. ' <br /> `UJ � <br /> Property Owner's Mailing Address: 7.0,5 <br /> �Poad/� lt� r �389 <br /> ity State Zip H <br /> PropertySite Address: <br /> Applicant's Telephone Number: !lS �9�j-'r[7�j 9 <br /> Applicant's Email:-! /`4&r 44A), _4";2,LDlA <br /> **If staff has a question about this application,you will be confacted via email. Make sure your email address is o <br /> legible and your email provider will accept <br /> 'e/mails from the following address:@BumettCountyWI.gov a. <br /> Legal Description of Property: N (J <br /> Section#: X? Town#:10 Al N Range#: W Town <br /> N <br /> *Attach additional page if needed for lengthy description OR attach apcopy of the deed OR attach tax system property page. QQ <br /> * °� <br /> Tax ID#(1-5 digit number;found on tax statement): ,71 b J� 9 0 1:, � <br /> Provide Rental Information o <br /> License Year Applied For: ,Zo,2j� Amount of Renters Applied For: N <br /> Local Contact's Name: //I2 <br /> Local Contact's Address: <br /> ry City State Zip <br /> Local Contact's Telephone Number: "/,S—29Q --74S <br /> ,Q � Z <br /> Most Recent Burnett County License Number: STR-,2'1-:70 State License Numb : �C/� - 0/ <br /> o va <br /> ARFA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLYtw <br /> z � <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: .X <br /> f - <br /> -1 C,ey�sc -Q,v Y-Es `?JI-2U 24, o 0 � <br /> �l Q,CEurd Gttnel R?,A+til 6u,L*d.e It hgS f0 bL. 0 PCta-WA w 1A .� s <br /> Cu,rrev�- ee lnS�Y1ulnAbe r a VIA C4wea Ste. I Aeenfie. I QL- <br /> V't,vhbCr <br /> Fee Rec: <br /> p CCupa r�CJe,+St n�✓tj- N,br' tD QY_C eM 2 (�pi e, � Ck#:�� <br /> I�r N-20 1 qKe. <br /> m <br /> Date of staff site visit: ,� �� J Initials of site visit staff: 1�- <br /> _ C <br /> CLM <br /> LICENSE APPROVED BY �il�I DATE: 1 / Val .) �° <br /> LAND SERVICES OFFICIAL m N <br /> 00CD <br /> rn <br /> m c N <br /> Page 1 of 3 a z <br /> Burnett County,WI Short-Term Rental License Application—Rev 11/2024 m <br />