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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WICD <br /> Applicant Complete All Sections Below This Line r <br /> Original License Fee= $300 ❑ Renewal License Fee (Annually) _ $150 a <br /> Property Owner's Name: (YA a-tt tj C,►—i n a r— � <br /> /� <br /> Property Owner's Mailing Address: 0 b 1 S Oeu-n-hi 12F �a✓ JGLr �i'V �/ �\ <br /> d(p S �yu� 1� E- bt�� City State Zip <br /> Property Site Address: � v► A-� y1 V1 5-19 30 <br /> ` cn <br /> Applicant's Telephone Number: 00 0 r, <br /> Applicant' <br /> ��ier► C�amva Nb� ! � �� ,Ccsrn <br /> s Email: <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following address: (r,BurnettCountyWl.gov CD <br /> Legal Description of Property: r6 v j 4 �41� *1 GSM J1b rc p C <br /> Section#: a`t Town#: 40 N Range#: b W Town of: <br /> *Attach additional page iif•needed for lengthy description OR attach a copy of the deed OR attach tar system property page. <br /> a s 3 r7Z <br /> Tax ID#(1-5 digit number, found on tax statement): d n o <br /> Provide Rental Information 2. , <br /> License Year Applied For: a0a5 Amount of Renters Applied For: !� S <br /> Local Contact's Name: 3-D e- 4- L- C,n Ck-, Ky[d erGV <br /> b <br /> Local Contact's Address: `� y S to fC 2Gl 3�� U S�r e r1 W rj `7 z <br /> 0 <br /> City State Zip (� � <br /> Local Contact's Telephone Number: x <br /> Most Recent Burnett County License Number: STR- State License Number:ATCP- 05y535 --- <br /> a N � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY -� d <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> 0C� AottA U pert' . N <br /> S(I g _ 5 <br /> q 3 <br /> n. .Q,n�' AII. I¢�be a 0 l�ld� t1eA.Y- rv�,eA <br /> L ett r L d-F LlUAS U� a Fee Rec: <br /> Ck#. <br /> x <br /> M. <br /> Date of staff site visit: 2� Initials of site visit staff: Y` <br /> C <br /> I n <br /> LICENSE APPROVED BY DATE: <br /> m CD <br /> y n <br /> LAND SERVICES OFFICIAL 00 <br /> a � N <br /> CD <br /> cxt <br /> Page 1 of 3 [1l! <br /> Burnett County,WI Short-Term Rental License Application—Rev 11/2024 <br /> U <br />