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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI VI r r <br /> 2 cp A <br /> Applicant Complete All Sections Below This Line G m <br /> = <br /> Original License Fee = $300 Renewal License Fee (Annually) = $150 2 <br /> C <br /> rJ 0 C Property Owner's Name: D avl G is 1 e2 e r a' <br /> 4-14 -,,\..3:1, <br /> Property Owner's Mailing Address: / 001 �'v lY $ 1�/V 1 0W c ''I Al 3"`3 o6 <br /> Pe Y <br /> / R pp ,. } City State Zip <br /> Property Site Address: 75`(/ R Gl f Z Rd U/+P, 5 � w� 5� 3 o Q <br /> 101a -7P3-�lr-2 <br /> Applicant's Telephone Number: r ' <br /> 0 <br /> �,/ F• � <br /> Applicant's Email: JZf 1 O i &-g/z'jaiJ'f CV m <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is R 0 <br /> legible and your email provider will-accceept emails from the followingy address:ad @BurnettCountyWl.gov =-�/ <br /> Legal Description of Property:/ b r7 M' iec s J✓✓ ofVeil ISlO Lt?B5/O, <,a i i# / o k/ <br /> 2 V yy��,, <br /> Section#: 3 3 Town#: 40N N Range#: /6 t) W Town of: CLX/ d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* — ( ' <br /> 3 3�l3/ o N 1� <br /> Tax ID#(1-5 digit number:found on tax statement): '' 2 <br /> Provide Rental Information ° -- <br /> License Year Applied For:P 0-2 / Amount of Renters Applied For: *g 7ve5/S in.Local Contact's Name: R/t14kfC d gee,r 'e svA 1 <br /> Q �� }y- �y�d�j Local Contact's Address: U p�c �0i��o �cf,J�. Rd /ivy J TO 13 0 <br /> Local Contact's Telephone Number: 6/9 ` O 75 /e o d City State Zip <br /> EZ <br /> BD <br /> Most Recent Burnett County License Number: STR-�3- 17 State License Number:KL6p-A8,03 ° "' —C <br /> a W x <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o W d <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: al <br /> n <br /> 0tiCt/ne- e p►res I31 /2o2,s -i d <br /> ID Nu,Rfot nc..-( cam( ad vtr4;&-e- 4--4+ no+ --1-0 - x GQe d $ pe.op(sk. o z <br /> r A P <br /> 1éD ) all LIc iS 1 VA)1.f4m-e-n !6- <br /> 0 <br /> 4 Fee Rec: / — <br /> Ck#: /322 R. <br /> m <br /> a <br /> m <br /> Date of staff site visit: 1 i 31 I�Z1 _ Initials of site visit staff: T r- J <br /> c_ 1 l _ <br /> 11u' <br /> E�iLlilJ�k `l <br /> LICENSE APPROVED BY ' DATE: 2 / 7 ) 20V 1 <br /> LAND SERVICES OFFICIAL m m tv M <br /> 0o tv o <br /> Page 1 of 3 a <br /> Burnett County, WI Short-Term Rental License Application—Rev.12/2023 a1111 <br /> �� J <br />