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Docusign Envelope ID:70204FBF-5B94-44A9-A669-E9D95CFA6CEB <br /> %ae mvix i-a . F%111 nr.11 i r%L. L4%,ce10c RrrLt%,.H PION — Burnett County, WI <br /> a r! <br /> Applicant Complete;All Seetioons Below This lane Q <br /> Original License Fee = $300 0 Renewal License Fee (Annually) _ $150 R. 7, <br /> Property Owner's Name: Ehla-kf [ i <br /> Property Owner's Mailing Address: <br /> City State Zip �3 <br /> Property Site Address: L1 5 �'P��(1� {' Q 0,04 10 cy ��(Itt;LM/� <br /> Applicant's Telephone Number: �Q " �4 —1 7 o <br /> r <br /> n y,� n <br /> Applicant's Email: rD <br /> -f! 1.2Ot f� . 12t�'J�{ {� ��j�_f r • hw <br /> **Tf staff has a question about this applicat on,you will be c tatted is email. Make sure your email address is k o <br /> legible and your email provider will accep�tfemails from the following address: @T3urncttCountywI.gov _ <br /> Legal Description of Property: La 3 C SM#104(P V I I P 241 tin fb 0 V LA 4- 0*2561f I vI <br /> Section# 03_Town#: N Range#: NV Town of: { 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." 1w <br /> �I J ro <br /> Tax TD#(1-5 digit number; found on tax statement): <br /> Provide Rental Information <br /> License Year Applied For:2D2 -20 2(o Amount of Renters Applied For: I1 <br /> G <br /> Local Contact's Name Oro <br /> ! r L ,� 1► I <br /> Local Contact's Address: 1121pAl�('il y( � ,T• ( L� LoX,p V [A) a <br /> City State Zip <br /> Local Contact's Telephone Number: ( �. ' "�-� <br /> n LLLL ''II <br /> Most Recent Burnett County License Number: STR- State License Number:rTTG P-QST� T m J <br /> AREA BELOW TRTS LINE FOR J ND SERVLC"STAFF COMMENTSICONDiTi0NS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: b <br /> s <br /> @,twts ItUvge-) o <br /> �e)r S,,n <br /> � s <br /> Ct A t D bc Sf-cu red Wc+. a L00t-A- cha� M i <br /> 4 Fee Rec: � <br /> Ck#: I(D—)-3 _ <br /> Date of staff site visit:5 S Initials of site visit staff <br /> 5-ZU-Z ea Z� (n M 11 u <br /> LICENSE APPROVED BY DATE:r CDC :r- <br /> LAND SERVICES OFFICIAL 5 <br /> 0 o <br /> m c <br /> Page 1 of 3 <br /> Burnett County,WI Short-Term Rental License Application—Rev 11/2024 CD f[�j <br />