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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI c r <br /> ' A <br /> Applicant Complete All Sections Below This Line • o y Li <br /> a eD <br /> Original License Fee= $n300,^I,n Renewal Licenseic^ Fee(Annually)=$150 8. <br /> Property Owner's Name: �')t t �" `� , t Pe {41.', , w s <br /> Property Owner's Mailing Address:2 0 �v'1t�,Fl m�t l AV e ��t V IV`ett 1 MNI `5r)I I rP Property Site Address: 1*7S 040-1-crS t `bGl, b t4Y14t� 54 Yt e0 Zi 0z <br /> }Q o((,^,rlrr < W <br /> Applicant's Telephone Number: ti? I -' ' 4'0° 0 I ".J 1 �' r ' <br /> Applicant's Email: f1 re,al ay) Lk ry 0) attlicro. C**If staff has a question about this application,you will be tacted via email. Make sure your email address is a F <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and P <br /> @BurnettCountyWl.gov k' 1 0 <br /> I t Legal Description of Property:1 r)7 "7 Ci, r t- Oh <br /> Section#: 2 Town#: 11 ` I <br /> N Range#: . W Town of: ASS <br /> *Attach additional page if needed for lengthy description OR attach a copy of deed OR attach tax system property page.* <br /> G c) © <br /> N <br /> Tax ID#(1-5 digit number;found on tax statement): as va 5• c A <br /> •0 ,,,,, <br /> Provide Rental Information 7 p °' S <br /> n (� r � d <br /> License Year Applied For: `O 2-'' Amount of Renters Applied For: I"✓ $ CI <br /> Local Contact's Name: ;h RN 1 I 12th r " 00 o. <br /> z <br /> 0 <br /> Local Contact's Address: <br /> I n . ;cc ° r City State Zip <br /> Local Contact's Telephone Number: IL oI"� <br /> :1 A-�CV'Mai 7 <br /> Most Recent Burnett CountyLicense Number: STR- State License Number: - 1V <br /> bQ 5 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS S BJECT TO ALL CONDITIONS LISTED BELOW: <br /> — L1Cell&e..j tY,OrtS 1 31 Zo v) R. <br /> r u IOLa dt/l has pt., W)/ se - ir. , <br /> z v, <br /> Occ_upal1ey nU1MI.tit' 40 ,-- 749 exc.e_e_c/ s4-A, x <br /> cmtAcid 1,4 rem S, by 7[t�23 y I� <br /> etpka bR ®S.ac ►1,ea nun <br /> SRQ- 'eA--+� r LL, N. Li(-existr,,5 0, tp r(,t,l tetv1't't.rt+S , Fee Rec:3CQw <br /> Ck#: 1 o 13 <br /> •L Use. ?Er iyx4- need ed -F,r 54-6:kIS 69 8 l t i2D23 <br /> -1)nty -ft be. UStJ AS a d X f ef"C i 22 -o t < <br /> mar (c.s(nb‘l ell t3 ,,T.),- l „{s Al, ion ke55a� C b to kt4Inn] <br /> P m j�6 a <br /> Date of staff site visit: ` 11 0 UJL2j Initial of site visit staff: 1-! '- 4<j--- <br /> o v�w D <br /> a , n <br /> . . < = Z <br /> vv <br /> LICENSE APPROVED BY ATE: Sill)z023 CO ...`a' © EN <br /> 0c.c <br /> LAND SERVICES OFFICIAL a a 0 ry <br /> o wZ <br /> Page 1of3 4 g <br /> Burnett County,WI Short-Term Rental License Application- Rev 12/2022 ? , I U U'u� <br /> J <br /> E <br />