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Applicant Complete All Sections Below This Line K y <br /> Original License Fee=$300 Renewal License Fee(Annually)= $150 a <br /> a e <br /> t. c Property Owner's Name: aAY quiex. 3-zkyx cS®In g <br /> l "�i n I i�2 <br /> Property Owner's Mailing Address: 11 �GY\• rCt5z 1) i d t✓l Vv l 5 4zl' y <br /> r� City State Zip 74 <br /> Property Site Address: 4 1 a S'+o -e a 7c t VU 0 'p S-1-P r i ' 1 5 9%9 3 ? <br /> 2 r I <br /> Applicant's Telephone Number: t l0S l 1Ia 7 — JC! r V\ <br /> __ 0 <br /> Applicant's Email: e W Y� ' zlfueiSb►� CD `k�rv1A 1 11 C e."-I**If staff has a question about this application,you will be contacted via email. Make sure your email address is b <br /> 1. •l.l_ 1 email ' 1_ - ill it. r.. the <br /> r.11 /.\n !1_ Wl L.� x <br /> leglule al1U you! ulovluei will accept ema11s noun file joilowllig add'es. IwDullleu.0ullty vv L.gOv I S m <br /> I '6.. lt, <br /> Legal Description of Property: vZ C M V I la 4' O lA-t1 C:;-} Li 0 <br /> - <br /> Section#: ©LA Town#: 3% N Range#: I g. W Town of: LU -Fe I l e. -e- N N 6 <br /> *Attach ar .. r_ .. a ar..r ._�a...description OR r. r.1. deed r. * g <br /> nttach additional page if nccueuwt lengthy OR attach u copy o the deed OR attach 44.4..system property'page. r C. 1 IC 1 <br /> Tax ID#(1-5 digit number;found on tax statement): 3 c <br /> q U <br /> Provide Rental Information O <br /> License Year Applied For: av aq Amount of Renters Applied For: IOW -`C <br /> Local Contact's Name: May\C. B YU ri V\C'V kivvth'e ✓✓1 Ken ‘. C 0 <br /> , i <br /> Local Contact's Address: tte-MTV" l2A`*G1 ( , q /5 173iM' Ave. ili"rnW 1 i sq ) rl I o <br /> 1v I <br /> City State Zip N <br /> Local Contact's Telephone Number: (oS. I 34 7 —3c ; x ^c <br /> FA h----- J <br /> Most Recent Burnett County License Number: STR- �3-C 3 State License Number:N W 0R-Gi: .'IT '" c <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY e <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: < y V <br /> Lac erns e W► resk 131I2015 cri ,,,., !a ____(::: <br /> a ,,, <br /> (D OcLv,ipanN DAJ c,+Avtr-11strak4n+ nvir -1-0 ex.cee-d V lat-oplo- 0 z <br /> OARDIA) Ca LjwnS in.) Ce?viit•e_tru."14-5 <br /> U <br /> c; <br /> G <br /> 11 Fee Rec:/5b <br /> b Ck#: 37/`) <br /> x <br /> M <br /> z <br /> m <br /> Date of staff site visit:5[ 1 t1 (i'► Initials of site visit staff: 61_4.111, 1 w <br /> n <br /> LICENSE APPROVED BY %%1L-9 DATE: 5 // 20Z1/ CD C <br /> -c <br /> LAND SERVICES OFFICIAL o 0 a: o <br /> CD <br /> -00 = = <br /> r <br /> Page 1 of 3CD nil <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2023 <br /> L` -J <br />