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SHORT T-TERM RENTAL LICENSE APPLICATION — Burne+# County. W1 <br /> Applicant Complete All Sections i"seiow"rills LanerA <br /> C1 Orizinal License Fee=$300 Renewal License Fee(Annually)_$150 I & z <br /> 11 I � � <br /> Proper*.'Ov•r:er's Name: d VyNuV\C� Jo� �V 0✓1 tl C I cr <br /> 1 �G e. v� I-E��1 �v I l <br /> Prope ;'O::ne 's!))ailing Address 1 E}e✓ �O �O 11 <br /> -7 City_ State Zipt-L <br /> Property Site Address: l a e e✓ w s ca <br /> �Tiii�iCc"tnS'�T?i ciihiiic*::imiicr' V�I� l l� �J� `� tl �. I� I t <br /> Applicant's Email: P��u►�G� c��V1�'rl t`� �'l '✓YlQ ' ' C <br /> **If staff has a question about this application,you wiff be contacted via email. Make sure your email address is I I b <br /> a •1 •n c w c n address: ng ettC ,.:Arl <br /> legible wavy gout ea:aa: pry:°)der'r'viaa accept eiTaail3 from the awa'J'r'riug address: �aa, uaTavaa vUnaJ• .2vv <br /> Leval Description of Property: CSM V LJ We 4 <br /> Section#: ('��Town#: 3 S N Range#:_�W Tovri of (-R (Gtl e- <br /> *Attach additional page ifneeded for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax IB#(1-5 digit number;found on tax statement): 3o�S 3 I ' <br /> Provide Rent-a'Taformation < <br /> I� <br /> License Year Applied Fui. 3 0?-,5 tlinuwa Vf Rentei s Applied Fut. n(. II ; - I c— <br /> Local Contact's Name: �AQ✓ V `.� t-`hY\e✓ —IV'y✓ e1�h �t���` �-o II I�, <br /> Local Contact's Address: �)�+�e✓y\ `lie vt4 a I LD� 't y 5- 2J 1 bt Ave W 1 � 59 im 1 o O <br /> City State Zip 9 <br /> Local Contact's Telephone Number: (0 S 3 Li-7 ' 3 5 g ✓ <br /> Most Recent Burnett County License Number: STR- aLLA State License Number:ATGP-0l I Gas <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTSICONDITIONS ONLY ,C)C <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW; <br /> i Li�ehSP� irekS l-31-O 2D2-10. ICE r�P Y ►� IQ ,� <br /> 115� a.�d acLarhg4WkLj& Nt�- -�po-e�p Geed (P <br /> Z � <br /> 3 acc�.v-d ��r r><Iai vl ..�,c�l�-�►� �.oa�- fi� b�v�d�d wc� � f <br /> ' `l' cpt y Fee Rec: 1 �— <br /> OlUpanc�.j l�i,m + a.V\d Pal"kk19 r�uir� by (v-3o�2dZ<5; � cl:#: 37 <br /> Date of staff site visit:S f 5�Zo25 Initials of site visit staff:IVl <br /> LICENSE APPROVED By • DATE: r- <br /> cn <br /> LAND SERVICES OFFICIAL <br /> m =3 <br /> mom^`. <br /> Page 1 of 3 00 <br /> Burnett County,WI Short-Term Rental License Application—Rev 11/2024 CD <br /> m <br />