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1 <br /> cr <br /> SHORT-TERM RENTAL LICENSE APPLICATION— Burnett County, WI a 1 ig <br /> cp <br /> Applicant Complete All Sections Below This Line a 2 <br /> d E <br /> Original License Fee=$300 Renewal License Fee(Annually)=$150 `. c <br /> Property Owner's Name:Noah & Amy Shadis \ 0-3 <br /> v3 <br /> Property Owner's Mailing Address: 234 Van Buren Ave N Hopkins MN 55343 °< <br /> ��City State Zip r- <br /> 27893 N Point Lake Rd,Webster,WI 54893 <br /> Property Site Address: � 0, <br /> 928 221- 7 <br /> Applicant's Telephone Number: 763- rn <br /> Applicant's Email:noah.shadis@gmail.com x <br /> Lot 13 of CSM V5 P191 (#204054)Map#1082 S28 T40N R15W CSM V5P 191 _ <br /> Legal Description of Property: Parcel ID#07-012-2-40-15-28-5 05-001-015000 O <br /> Section#: 28 Town#: 40 N Range#: 15 W Town of:Jackson N — `� <br /> tA E <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* oip ' <br /> P n N <br /> Tax ID#(1-5 digit number;found on tax statement): 5811 a. n N <br /> . <br /> Provide Rental Information <br /> License Year Applied For:2024 Amount of Renters Applied For: <br /> N 0 a <br /> Local Contact's Name: Dan Shadis w' P. <br /> 509 N Park St GrantsburgWI 54840 "'" <br /> Local Contact's Address: ,D <br /> Local Contact's Telephone Number: <br /> 715-463-5408 City State Zip — W <br /> Most Recent Burnett County License Number:_STR- 2' 'ZS State License Number:_MDON-CH5M7N 'r -� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: f <br /> 0Lite,r,s-e. -ezv'ifeS 1I3t12°25 a y <br /> �C uQfJ�I'1U� and ad�er+�:ae-n Xt w\o+ -b -exc.ee�1 1-1 �- z . <br /> NO- and C,VuiNA vl ee Stei c 4-0.6k l'►c.S b1 I-t I►s/WV-I __. <br /> 10/ Rim4cut 9 u,(Lai►' --E) bt_ ?asl-ed. ou+s;cik rye ar racu n -er unc-e d <br /> 19'-( La/i s/2o2q. se- _ I,6- (L) 4 Li c-e ns► n5 Ee2u1 rt►-►1o'tfS <br /> v, I Lam� -I/ <br /> � Fee Re:: <br /> OW :Ocl Shk.C1 Dr l -/� nQ L.S a IA5.. etr014-� `112 11 Z.o Ck#: <br /> Date of staff site visit: Li hui IZ023 Initials of site visit staff:ck(I 4-6/L <br /> LICENSE APPROVED BY � DATE: 410 ZeZ l z "slik <br /> o LAND SERVICES OFFICIAL r ' To- <br /> -e a e <br /> � 3 70 <br /> nr1 s ~ O DB <br /> al 0 p o '� o <br /> Pagelof3 4 al <br /> Burnett County,WI Short-Term Rental License Application- Rev 03-2022 a -a- <br /> li El <br /> m a <br /> p. L� ).) <br />