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r <br /> 1 E <br /> � A <br /> SHORT-TERM RENT_A..l LICENSE APPLICATION—Burnett County, WI g.. I 2 S <br /> eD <br /> Applicant Complete All Sections Below This Line p I• &. ° <br /> PD 2 <br /> Orisinal License Fee= $300 Renewal License Fee (Annually)= $150 <br /> Property Owner's Name: tet-C/ `" Nt r <br /> isg <br /> Xi <br /> • C N <br /> Property Owner's Mailing Address: � -..c;% �7 5. \,.....J.1 4 N <br /> - r/ r <br /> PAY � �� � r`' �'�"� � `" -� � (.�i ���,. State �..� �r F w o ' <br /> Pro Site Address,: � ..� � e � 0 �,�' �l �1 <br /> Applicant's Telephone Number: i/S " S3 f -- CP/elCO <br /> 2 i <br /> Applicant's Email: J _{,alier_/ G = ` ..' rt . <br /> LegalF.DescriptionProperty: �i�c / CS/' /ST7V ?1 � / 'P ; <br /> of <br /> / s <br /> Section#: 0 Town#: C / <br /> N Range#: 4/ W Town of: f.G /Z K VI <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* oo a... <br /> P. C, § <br /> Tax ID#(1-5 dieit number;found on tax statement): aF41/2 ' k. C W G• <br /> 0 <br /> Provide Rental Information ��„ <br /> lT �. c. <br /> License Year Applied For: AmountofRenters Applied For: /12� < a1-/L12 ,' / <br /> i 7 <br /> Local Contact's Name: ,te rj_pi ®11 air i_ t\!_ IA' SW a r1 .0 ao i. 9' <br /> ,o <br /> z <br /> Local Contact's Address: ,�= � p� <br /> �■ o �rmalsg . -Arjwi' .— N <br /> City S //,,Zip <br /> Local Contact's Telephone Number: • ialC�'Zn1 r.��Lsjis 1&a�, /�J ( z <br /> rn o• <br /> Most Recent Burnett CountyLicense Number: STR- � R t--, <br /> ' y <br /> State License Number: • o 6 <br /> AREA BELOW THIS LINE FOR LAND LANRISERVICES'.STAFF COMMENTSACONDTIIONSERILY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: , 8 S <br /> Lova\ c;\. 673 3.ehnsoi► Lake- Ra. ( t - 7 --- O32 ) <br /> o p c <br /> ,)6 I.\cen5e, e1.piCeS \ -31 - 23 z w <br /> i 0 CG '9aA c, 1,m ,35 k0 ?eo?)e.i, %AG\o C I Vch;\dcen . <br /> * La 04C.1f\akn ori a\\ ma- ho\els - .0 se/0k • a <br /> ti <br /> trir Fee Rec:/53-69 <br /> Ck#: 4,757 <br /> m <br /> Date of staff site visit: 3 — g - 2-2 Initials of site visit staff: K L PiPi <br /> LICENSE APPROVED BY : joiZ""` -4 f (N` DATE: 3 - el - 12. C3 <br /> LAND SERVICES OFFICIAL <br /> m <br /> Iluu <br /> z3 aD 0 <br /> Page 1 of 3 v 0 �, c <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2021 1 S S O Q <br /> '' ' <br />