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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r <br /> a fD n <br /> Applicant Complete All Sections Below This Line < y <br /> C 0 CD <br /> Original License Fee= $300 Renewal license Fee(Annually)_$150 a. <br /> to ill tuA" got0`.4..) ✓ d g <br /> Property Owner's Name: W Y 7 <_) 4-C Ci. --41/ ZeVre i,lt i(e- /1/11/ 5- -10 7 =%` CD <br /> .1 <br /> Property Owner's Mailing Address: 9 . <br /> 1l2T� c�JCity State Zip 7d <br /> Property Site Address: l (c`- , ��'�•? _ c t"o <br /> (Z 3?7 v2y� s <br /> Applicant's Telephone Number: r Q� <br /> Applicant's Email: <br /> 13 i t 16") `"r4C wY �-, i i lI/3' c e'-L, . a d <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is ril b 0 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 5• 1 <br /> @BurnettCountyWI.gov _ S a. <br /> Legal Description of Property: t4)f 11 -s - tfaj>, e i-i? A-4 £ lei- I. o <br /> Section#: Town#: 14) N Range#: t y W Town of:, : %G 74- <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C n N <br /> Tax ID#(1-5 digit number;found on tax statement): 1 Y y Y3 4. 4 A <br /> o 4 <br /> Provide Rental Information � <br /> License Year Applied For: 2Y' Amount of Renters Applied Fo - +� <br /> W <br /> d^ b <br /> Local Contact's Name: 1 r e7 d0 z ' <br /> Local Contact's Address: 5 6Y3 T—Ail y/d 4,-at,4.9. Ar, 5, e., Aid-1,-1, s yao el N <br /> Cs, <br /> �WU City State Zip �I <br /> Local Contact's Telephone Number: &I� /� <br /> Most Recent Burnett County License Number: STR- �f v c�3- ' 1 State License Number:�L /)'S N , <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY -j — <br /> THIS LICENSE. IS SUBJECT TO ALL CONDITIONS LISTED BELOW: °�� <br /> DLI'CQ,Y1C-c. ek?ire5 1 ( Z02- <br /> Ocvc -i OO,nd acki.v_l-is,e.► n-i-- not --10 -excad 16 ff,6 It- z <br /> 0 Ste-hc -lank l id(s)-to 41-e paierty stautd ixi--1-k a it cnd .c <br /> c-lAct),rt x <br /> FA <br /> 01F0/cow CW Li WI 11 9 ee.tteo n +-s 1&r Fee Rec: <br /> v Ck#:30—/7 <br /> afrdak CoAy lice-6e f2uh2b -k( V) year <br /> `° U <br /> Date of staff site visit: i //41/2123 Initials of site visit staff:L I <br /> zn inn] <br /> U <br /> rw� m <br /> 0 <br /> DATE: I Z 1�5 �22 c <br /> LICENSE APPROVED BY :� 'm '�,nI <br /> CD - Uuu <br /> LAND SERVICES OFFICIAL '—= N o <br /> Pagelof3 0 w <br /> Burnett County, WI Short-Term Rental License Application-Rev 12/2022 ti a • <br /> x <br />