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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r r <br /> Applicant Complete All Sections Below This Line N• n y <br /> g <br /> Original License Fee= $300 Renewal License Fee (Annually)= $150 a <br /> Property Owner's Name: (lab r l-G1 q L'< 1-f41 Y!at P.e rresn ?e i't f cr)0 v E <br /> Property Owner's Mailing Address: 1159 PII�11 IC S SI . Rat ki k MN .5/13 y <br /> J v �,� �" �� LCi y -7- State Zip <br /> Property Site Address: 252.9 2 p i ice. � -V't Rd • ( t/s;4OS7c/► W ,1. via o N <br /> Applicant's Telephone Number: (si12 2:7-C) OC:1 s r <br /> Applicant's Email: k-pe rr 6 i 6/10t.I I -C a Yv <br /> **If staff has a question about this application,yoVwill be contacted via email. Make sure your email address is V1 0 <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov g <br /> M <br /> Legal Description of Property: C Of I C5M V 15 P2 02- (6O Y t OT s?) § <br /> d <br /> Section#: 9. Town#: 31 N Range#: `� W Town of: M�Gn 0(/) N <br /> "Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach taxsystem property page.** -- <br /> Pg .f f SY P P P h'PS .• w �. <br /> Tax ID#(1-5 digit number;found on tax statement): /18 y 3 P. n o --, <br /> g• ! 1 <br /> Provide Rental Information <br /> e . . <br /> _ <br /> License Year Applied For: 70 Z1 Amount of Renters Applied For: 4 i <br /> rs 4. <br /> Local Contact's Name: Kai ?mac- 41 S 61n fD oci <br /> Local Contact's Address: 2`711)- `J 6 in t GMot_ R c( 1 e,bs Jr AT tJ 3 o ►� <br /> r1 q I- Siity State Zip rj N r I . <br /> Local Contact's Telephone Number: 3� q 1 GCS ✓ 1 2-3 o -'/ ,j <br /> 71 <br /> Most Recent Burnett County License Number: STR-23"" Zg State License NumberNIV Og, C ikii t d `� oQ <br /> a N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 6 01t7 <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o =----- <br /> CI Li(tnS-e -ex o,re 11 t /202 6 P, W <br /> W <br /> !It -b -e Kc�e�c1 it � -o 1,Z. <br /> Cc c.�a t1c.-i and adv2r `4 0 z <br /> Minul -1-1.0. Yv1cu✓‘ cLk,eQ,Q. r19 Cry vt 6e Y.-CA-kJ .l /iS/loZ <br /> Ul� Gt i n nCd an -r!i c -lu n�� �cS y `� 0 <br /> r. 15�° <br /> Vf.. R fot c b (-v/15/ t ocLpa UG7 Fee .3 <br /> Ck#: z <br /> C�,.�,d�1i Placard -� Y <br /> 11 lY1 4 j S , 6 r AL-1-1- Cott n+ti L►c,e n se r1 kmbu ) 1 <br /> - <br /> Date of staff site visit: I � loz'/ Initials of site visit staff: I r- —��J <br /> LICENSE APPROVED BY � 2y212g Q. <br /> DATE: m T <br /> <,3 x� <br /> LAND SERVICES OFFICIAL m c iffil <br /> oS c-ti' <br /> N_ r-= <br /> a <br /> Page 1 of 3 ,`< N <br /> a ..0.- <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2023 �Ul <br /> L )J <br />