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y <br /> SHORT-TERM RENTAL LICENSE APP I A ION — Burnett County, WI <br /> r <br /> Applicant Complete All Sections Below This Line p <br /> ''Original License Fee = $300 ❑ Renewal License Fee (Annually) _$150 a <br /> d <br /> Property Owner's Name:�1��4�(d�A��� �✓'V ©off <br /> yf/yf <br /> Property Owner's Mailing Address: Q rA <br /> State ity Zi "q <br /> Property Site Address: � G�� ,j � CO O <br /> ti to <br /> Applicant's Telephone Number: 7Y <br /> rr o <br /> Applicant's Email: c5�, <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is x c <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov _ <br /> Legal Description of Property: J`A,A'17.3 nAAj Te L je)y4C,0, �-���-—�Jz <br /> Section#: /0 Town#: N Range#: W Town of: Z., N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the dee OR attach tax system property page.* V w <br /> Tax ID#(1-5 digit number; found on tax statement):K 7 N <br /> � o � <br /> Provide Rental Information rp <br /> License Year Applied For: �,��� Amount of Renters Applied For: f <br /> Local Contact's Name: 619�z J W 11 <br /> Local Contact's Address: _l /V <br /> Ci State Zip t <br /> Local Contact's Telephone Number: <br /> Most Recent Burnett County License Number: STR- State License Number: TC{�-�SSjl Z <br /> a � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o d <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <br /> o CW+ G� Qi&a o_&LtA- emeyvks rcl�av -e>ac e�ec! $9u e§-s z z <br /> Inclu,.d.i►� C,h;tld.v-elr, � ��osc�. <br /> 3� 1�2v��tzi.1 u��c�e liv,es -b lac �bst{d ou d e� V��ea� vvt is e h �ev�tra vlce, t <br /> d <br /> dbOV bU q-�- ZD2S, a Fee Rec. Q <br /> J K Ck#: <br /> x <br /> m <br /> Date of staff site visit: �C�- 2 S Initials of site visit staff: L6 <br /> CL <br /> LICENSE APPROVED BY &A4 DATE: m C <br /> < 3 r <br /> LAND SERVICES OFFICIAL y w <br /> o� o <br /> o Q <br /> Page 1 of 3 3 Q <br /> Burnett County,WI Short-Term Rental License Application—Rev 11/2024 <br />