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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r <br /> ... <br /> c. CD n <br /> Applicant Complete All Sections Below This Line 7. co = <br /> o w, <br /> Original License Fee = $300 Renewal License Fee (Annually) = $150 <br /> Property Owner's Name: 1 O(L U(Z-V' N # M LI"?'L, 1 ` k. 1-_-; c <br /> Property Owner's Mailing Address: 1 04 ( ?� DAkc, RA p e4J gA' (.IN ME.1 �S t eL. <br /> i City State Zip o 1-32 Property Site Address: 0 f3'L 1 L> -- ..t 00 A b R, G *-c l , lei( SC`t e` -o o <br /> Applicant's Telephone Number: Cpc I Li a \ -c 1 Z--7 <br /> V <br /> A <br /> Applicant's Email: 6; bln Ia le ) r(ae• c a,..} ka . C.flM g <br /> **If staff has a questioriebout this application,you will be contacted via email. Make sure your email address is x O <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and <br /> @BurnettCountyWl.gov o - <br /> Legal Description of Property: ? 4 LQ M I 4 LJ V 1 P c I l <br /> CD <br /> Section#: 2 1 Town#: V) N Range#: 18 W Town of: TR,_ LLL N --L Iv <br /> W <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* oo -- <br /> O CI: N <br /> Tax ID#(1-5 digit number;found on tax statement): 'IS ‘S :ri A , <br /> o % <br /> Provide Rental Information 74:4 c <br /> License Year Applied For: '74)2 3 Amount of Renters Applied For: C <br /> -q e <br /> Local Contact's Name: G it-1 3 ce vo 2 • <br /> _ r , `` z <br /> Local Contact's Address: �-t(c,C 232 O d S`- / ash( 1 q L.11 c l"TO°c., --9 <br /> / _ J City State Zip -C •' <br /> Local Contact's Telephone Number: W I `2.1v - ES 9- -A .,,,,,_. <br /> 44 <br /> Most Recent Burnett County License Number: STR- State License Number: D0t' - CPL K X 9 N 0x <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: g N <br /> W <br /> •L i c e nst Q.X.pi rLS 1 131 2c2q , - — <br /> Lock and C ap.n feed d Dr) Strlic. -}unk lic, a+ all -4-ii&z z a L CSC <br /> • EGe_r 5c tl.L i►leS -fo \ae pos-fed r1 CL( op ie.- -(m_ m . n-bi vic e cloy- 1� .... <br /> See, k.t-ge.A (1-) o5 Li ckAfa i►t9 �v .ve <br /> re ,rii-S <br /> 'DLO f 10..1 OXd a be,l'-I-►-Sa2.rA.t n+- n o+ +0 VC Cee„cl 7 ft.ofte baled On <br /> 4 `f1014Li nci -f kyik Site- ° rfi <br /> o (Rx(4 c•At.e} J a Fee Rec: — <br /> -�' 1 a o^�uS- - be r emoNi z . 12 131 j2023 ark:1 v e9e,-l-a-�ed it %I'S 069i,rx,�l Ck#: Cori' <br /> S-64-t. < <br /> �e 1.1 �'e YY1 Q.t L n <br /> follow Lic ense`] `C cn �.� <br /> r <br /> Date of staff site visit: -1 / Initials of site visit stafFK ' o W C U t <br /> LICENSE APPROVED BY DATE: 712E1 /z023 <br /> n rr� <br /> LAND SERVICES OFFICIAL a c o C <br /> m 3� N <br /> w <br /> Page 1 of 3 <br /> Burnett County, WI Short-Term Rental License Application-Rev 12/2022 i <br /> J <br /> ,, <br /> m <br />