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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI <br /> r <br /> a. ro n <br /> Applicant Complete All Sections Below This Line y A m <br /> c tD <br /> Original License Fee = $300 tenewal License Fee(Annually)=$150, i. - <br /> d <br /> Property Owner's Name: k,z,44,/ /C s 4 i•(yam 7 o Sc'i2 <br /> Property Owner's Mailing Address: 2-79 75" /40S-of D r, .bS ;r,iv,' 69 3 <br /> �l City State Zip <br /> Property Site Address: �7'p � /„(Rd e ,bfk.�`� eot o ' <br /> 5"�!�'93 `_' �► <br /> ,p <br /> Applicant's Telephone Number: ( S---S7n f ej j r r W <br /> Applicant's Email: Y` r't,I-.6„nd fe-t-ri 6 Ce n7'vey i . Na-i' DI <br /> **lf staff has a question about this application,you will be contacted via email. Make sure your email address is b o <br /> legible and your email provider will accept emails11from the following address: @BurnettCountyWI.gov a <br /> Legal Description of Property: .) /v 0 <br /> £c w T . C <br /> o <br /> Section#: /4. Town#: 11 U N Range#: /. W Town of: -,I4uL S o 11 a i <br /> > s <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* - <br /> a5Tax ID#(1-5 digit number;found on tax statement): I Le P. N o <br /> < l <br /> Provide Rental Information =� . <br /> \--N C/) <br /> License Year Applied For: oaI2 T Amount of Renters Applied For: ! g V <br /> nn <br /> Local Contact's Name: R.0,,q ire-9 ROScoL) 0 P' <br /> Local Contact's Address: 7q7 No ���t 6r ch5-re./ Lod'. 5 I 7. z <br /> City State Zip (N <br /> Local Contact's Telephone Number: 7(C— g(o Co — i( b S <br /> f 00 <br /> Most Recent Burnett County License Number: STR- 23"117 State License Number:NW0T-CG21{505 . `/' <br /> x <br /> AREA BEL$W THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 7 170 <br /> [7 <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o W <br /> Li Ce1r 2,SLp or-61 3t 20257 0 <br /> -J <br /> Q <br /> DCL, a14c Oi '+wtri-- (1o4- 4-0txc d IX' pi/if' p SitN� 0 <br /> D N4 k � be, by rzi as 0- \b•�e.\ 1hole,l 1 b+b -- ax-4- a A L <br /> r2zune, . —fits 'is a 'irle)k -�c),mi i'-{ o -Mirky' <br /> D R01401 0'w cL LDS *o be.. f tS-i(,i ol.L-bj cLt Ruti►' - Y\l u t Vl '► t W Fee Rec l' <br /> n125- <br /> Ck#: 5-/e2 F" <br /> door bk( l9 I t j2D24. S.e e.. 1t.i-- LL tt -N,t.Q. L;eVr1S1�►9 2uir n A <br /> Date of staff site visit: 2 22 2 D2y Initials of site visit staff:'k� '— l ��-J,n <br /> w Orli <br /> LICENSE APPROVED BY ,P DATE: Z 2 3/202/ co m W i•r` 0 <br /> LAND SERVICES OFFICIAL 2..CDa. <br /> Co o <br /> ray <br /> Page l of 3 i.= <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2023 = - Ind <br /> ill <br />