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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI v) r <br /> C N A <br /> Applicant Complete All Sections Below This Line a g <br /> g <br /> g es <br /> 0 Original License Fee= $300 D Renewal License Fee (Annually)= $150 8. <br /> d B <br /> Property Owner's Name: Ar c]t1 c G ,no.. 12i:scja.1 1 G a' <br /> Property Owner's Mailing Address: 1 943 Li S I r a..I o-n cl G� L a ke,v;11e) M 7•1 5` O 1-/ , 7 z <br /> City State Zip <br /> Property Site Address: 7! '7 fo Rr-e_.rr+ -Fe.cl Rd D nn 6u,y , CU 1 St-1 83 C] o N <br /> J,` cII <br /> Applicant's Telephone Number: 4 52-2.5a-Li a as r <br /> a <br /> Applicant's Email: 9 'r10. • r-I sdo.I I e 3 Ma.. 1. Ga M n <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is ril <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov t, <br /> Legal Description of Property: L•dt 9 , ela c.Ic. 2, Oa e„lo.ra S k rer S ° ti <br /> Section#: /6 Town#: y O N Range#: I Cc, W Town of: 0 ck le-l(34-J 1:-.) <br /> ! (Z <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach tax system property page.** •- <br /> P g .r f g Y P Y P P tYP S ?• <br /> vo `'' <br /> Tax ID#(1-5 digit number;found on tax statement): 1 �-1 7 9 S d n <br /> N <br /> Provide Rental Information 4 � r <br /> o v k <br /> License Year Applied For: 2.o 2.5 Amount of Renters Applied For: r.-n, . e f- 6 <br /> : • <br /> J . , <br /> Local Contact's Name: De,..,-, c Ar,j M;-Vc.l,e.l 1 <br /> . <br /> Local Contact's Address: <o o t R L-alc.c. 241 Rd C ,Lug-y , WI S 4 3 a o <br /> City State Zip <br /> Local Contact's Telephone Number: 651 - 9$3-232.9 x <br /> Most Recent Burnett County License Number: STR- )€MJ State License Number: ATGP-OSS762 ° c4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 8 <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: tri <br /> °I 1 V1ls �ICQI/lJplces 1`31'2_62_7 <br /> rn <br /> S�vv w v1,Dt- ILV—C eed 4 uQS d <br /> O bC� C (�in�, Q d veY�t z E , <br /> 'pQ.►r 5av111tt vc 4 277o'g• _ <br /> s <br /> cb1((AA) O l LCev>svo Y,e ttretmet 6 <br /> .1 Fee Rec:3cy)°D <br /> 4 Ck#: '5 '/ <br /> m <br /> Date of staff site visit: 10,2312025- Initials of site visit staff: "K Vl <br /> sz M <br /> 6(4,2adout.e,0-7x DATE: s' -27-2,D2S W Q (�LICENSE APPROVED BYc -�-s <br /> 0 CD <br /> LAND SERVICES OFFICIAL o c csi <br /> CD N c� <br /> Pagelof3 3 "' <br /> Burnett County,WI Short-Term Rental License Application-Rev 11/2024 <br />