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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI cip r t~ <br /> eo <br /> Applicant Complete All Sections Below This Line a CD p <br /> g <br /> c <br /> Original License Fee= $300 Renewal License Fee(Annually)1$150 ) CD <br /> • A.. <br /> d <br /> I <br /> Property Owner's Name: Lind on J-ex'o-r i.e_, < o' <br /> J � <br /> Property Owner's Mailing Address: l,QO pa 1 a C-h� -6 NA S El4 M Ovid S 9"739 KcA <br /> A 191 3 �j City State Zip Pt <br /> 1-3 <br /> PropertySite Address: �02�G O A d �' <br /> N <br /> W <br /> Applicant's Telephone Number: -15 -at a S- . S S 9 g' r'' <br /> Applicant's Email: t A Yl d O✓1 S C,U.S+D Wl I(10m tS !ctn.-la:4k . wry, <br /> CD <br /> **If staff has a question about this application,you will be contacted via mail. Make sure your email address is N m o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 5. n <br /> @BurnettCountyWl.gov " <br /> Legal Description of Property:parceA 0' land IOCa}cd iv1 100.W\YVi-(,vif 0-i' 1:-'? <br /> Section#: Town#: l-{'0 N Range#: fit{- W Town of: SGO�I N -Ck <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* as ,4. <br /> � P <br /> Tax ID#(1-5 digit number;found on tax statement): A1'53 1-4" <br /> o S <br /> Provide Rental Information <br /> License Year Applied For: O 3Amount of Renters Applied For: N <br /> Local Contact's Name: ccund� Mum <br /> 1(`�1(�Q�,cal w I <br /> Local Contact's Address:Xj1 Il,Q I ShOYtU lett Dr. v ek (AU, W. 94730 •�/1 <br /> City State Zip p <br /> Local Contact's Telephone Number: 1\5 A 51 - 11 13 Z <br /> 1, v, I <br /> Most Recent Burnett County License Number: STR- a1 A - 0 1 State License Number:NG(V-t\ -�JQU 1 l.-�JF c- 5 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY J <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: • g - ! <br /> - Li c en s-e .2u,pi r-e- 11 31 izov-( —1 <br /> z <br /> -LOc k and o on .5-e pfi c a-+ co) -t-inAL <br /> t <br /> pcLu pa,a Old �ir�,�e,� ;�,•te.,-�,�- no+ - ex geed If y <br /> v Fee Rec:/y5?)c� <br /> - l vl wi- l i(J/i n, re?GU Ie 111't o Ck#: aU�3 <br /> c' <br /> z <br /> rn <br /> rn <br /> Date of staff site visit: 'i ZOZ3 Initials of site visit staff: �6 Y /C / <br /> l Inn{ <br /> rz- n u"u <br /> LICENSE APPROVED BY ATE: `JzLi,izJ23 <br /> 07 D 0 <br /> m c <br /> m < = Z inn] <br /> LAND SERVICES OFFICIAL p fa. <br /> a ^.1 i u ] <br /> Cal c=3 <br /> Pagelof3 ° w o Q <br /> Burnett County, WI Short-Term Rental License Application—Rev 12/2022 I `o <br /> nil <br /> x L J <br /> ri <br />