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WORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r <br /> r <br /> Applicant Complete All Sections Below This Line a f D <br /> o <br /> � G � <br /> ❑ Original License Fee=$300 11 Renewal License Fee (Annually)_ $150 <br /> 0 <br /> Property Owner's Name: l l\V `ti/ . l�V��2t k� •C�u2t2oC_t� C 12-L,tT " Q <br /> C j/14vFtVLauZC� <br /> Property Owner's Mailing Address: zZ G U s0 . s� �-°RIB LV U <br /> 'ty State Zip <br /> Property Site Address: (U 6�, � _ S' (L Y j2 l-�� k�ug. l✓L 4-rl.rs <br /> Applicant's Telephone Number: �U-7-2 C©l �', 3 �i4E G r ' <br /> Applicant's Email: 6 /14NQZ.4)L L, 1\-A-4 i L 0 ( C`1_04 C> <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is x 0 <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov <br /> Legal Description of Property: 1�5� S�L V 'c f� L t< 1 <br /> 00 <br /> Section#: Town#:�_N Range#:4_W Town of- LA 'C 0CC 1 �---t V t-I` N (� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* .- <br /> OQ <br /> / G 2 `� <br /> Tax ID#(1-5 digit number;found on tax statement): l� oti <br /> o <br /> Provide Rental Information ° <br /> License Year Applied For: c> Z Amount of Renters Applied For: <br /> �" W b <br /> Local Contact's Name: ' ky iJ �2-1 71,E ,._,,�y_ <br /> Local Contact's Address: S S(L Vc� L� /� ' ��2/�-/�I�S (`�`-s t C o <br /> q City State Zip V <br /> Local Contact's Telephone Number: �U� '-z �f'� — l �7 <br /> HTCP-00g3g014 <br /> y z <br /> Most Recent Burnett County License Number: STR- z A <✓ State License Number: r �°, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o N <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: y 0 <br /> � N <br /> -9 <br /> a � � <br /> Zo2-4 -1- 2026. <br /> -T�h is pe,�r r►it- s z z � <br /> O oc�� � _ o <br /> Fee Rec:3�0. <br /> Ck#: — <br /> Date of staff site visit: '—� Jr`—ZS Initials of site visit staff: - <br /> Q <br /> �I(�JZoZS _ <br /> LICENSE APPROVED BY DATE: <.CD <br /> 3 <br /> LAND SERVICES OFFICIAL o 0 oa <br /> :o c N <br /> c <br /> 3� Rey. <br /> Page 1 of 3 ro <br /> Burnett County, WI Short-Term Rental License Application—Rev 11/2024 C� <br />