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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI c r r <br /> r) .. <br /> Applicant Complete All Sections Below This Line n. p <br /> 0 N ez <br /> Original License Fee = $300 Renewal License Fee (Annually) $150 E. az PropertyOwner's Name: r `t VT€ (' a �� � c <br /> al 2i <br /> Property Owner's Mailing Address: 5 16 c=. _ ► ..- QZi J (;QC. ` it'11 i c4 tam Pro(, �', <br /> City State Zip 0'3 <br /> Property Site Address:G -I 1 i Lr i�jE P Is , ,. r1`ti Y?"-)r-i 5 6 ill o p <br /> W` 3A Applicant's Telephone Number:6 ( 2-- -r c i c- 1) .," j <br /> Applicant's Email"i S'\- �c4,4 \..1� , e� <br /> **If staff has a question about this apilication,you will be contacted via email. Make sure your email address is k O <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and i. <br /> @BurnettCountyWLgov o• <br /> Legal Description of Property: 6- i l t (a�� 'D\Z 4 d CD N <br /> Section#: Town#:_k t N Range#: \-4 W Town of: S\NI SZ W 11- <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* tnz <br /> - C o <br /> Tax ID#(1-5 digit number;found on tax statement): Z Z3 Z C 5. < . g <br /> o <br /> Provide Rental Information 7O w <br /> License Year Applied For: C.J`-' ) Amount of Renters Applied For: <br /> Local Contact's Name: Gsk d S v oo <br /> Local Contact's Address: Z6 1 '6 �\(., L.,c tZ�„ W viSS7 L. p <br /> . City State Zip <br /> Local Contact's Telephone Number: -1 \ -6 Z,7i3 ' ‘ (.-" U(8,S <br /> Most Recent Burnett County License Number:_STR- Z. -08 State License Number: i'N)&I L VA - (Al <br /> 1314Pca- ' v VI 5 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �' F N <br /> -LictfiSt- kX�;reS ` )3t 12oz I --c cA w <br /> Du ttot S\no (' -A-0- b.e._ r-unov�ed Or Comt(&-kd -1-o San,►40J'( S`lS r`'' z LA <br /> b\,( 3) 1 )2,023 . I-, <br /> • ocw,?uny (nJ aavef-i;a-c .y,+ r\o� .0cLe,ecl ewe Le- <br /> z <br /> DI <br /> '14d.1-C rf( -a,I 9wAt.line.s <br /> m fA <br /> r Fee Rec: �— <br /> Ck#: 30a2. <br /> kettilti Sul Wcli itts —o \/(. po&l y e,av -e I'►'c6 4 p a n ce F' <br /> S-e e, /C-4-It" (L. 61 Ltc.eri5ifq 12efu4;reinter/5 m <br /> H <br /> Date of staff site visit: 27 2p23 In' ials of site v' it staff: ' ` C� <br /> o <br /> � y2oZ3 z <br /> gig <br /> LICENSE APPROVED B DATE: j ce W D 10 <br /> LAND SERVICES OFFICIAL z 2'm c I�,�,, <br /> UuU <br /> Page 1of3 ° o= r..) o <br /> Burnett County, WI Short-Term Rental License Application—Rev 12/2022 , , w <br /> n11-111 <br /> co <br />