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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r r <br /> � A <br /> Applicant Complete All Sections Below This Line a y <br /> C1 Original License Fee=$300 Renewal License Fee (Annually) _ $150 Z <br /> r i �,'t� l�ra(c�c'�Ia-✓ <br /> a• <br /> Property Owner's Name: ti eD <br /> �f• 7 �r <br /> Property Owner's Mailing Address: �y <br /> �/ / a City State Zip <br /> ��Property Site Address: ' Z f I LG`��' ��/ ✓\ �� � 1N� S 7a��� ° N <br /> Applicant's Telephone Number: CD <br /> Applicant's Email: 6� 'y"1/� fv+ /3 CD <br /> C <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is O <br /> legible and your email provider will accept emails from the following address: @BumettCountyWI.gov ' <br /> Legal Description of Property: <br /> Section#: Z 1 Town#: N Range#: W Town of: Je 0'� <br /> o .C. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* -r <br /> Tax ID#(1-5 digit number;found on tax statement): ! O l (U d o <br /> Provide Rental Information <br /> License Year Applied For: 2v L Amount of Renters Applied For: <br /> i2Ny b <br /> Local Contact's Name: CDb <br /> - dr <br /> Local Contacts Address: �1 0 <br /> 1 z y City State Zip <br /> Local Contact's Telephone Number: �Cj � (COI LOOP � z <br /> Most Recent Burnett County License Number: STR- Z 3 -State License Number: N o0 <br /> c <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 /> 2a 2(p. m 0 oe <br /> a � <br /> U C,Cu Pam' + ad fie. is��rne,vv4- �o� `� S Peap (e �oe� z w <br /> ►'tea-`' me V1 door ►2P,w-fat ut�lelIV) <br /> i-o b�updcL <br /> 1.kb Y Vl1�1,W1or 1 U r �015 Ph6Vl�P1(,t,� 1211 +I Fee Rec: <br /> ew ct& Ck#: -3/LU' <br /> �1 P U) In <br /> O Fo G lu vJ CLU L�(ev1S'yn r rew� <br /> Date of staff site visit: 2,- `2.01� Initials of site visit staff: Le + V-6 r su (nn1 <br /> � 11 �111 <br /> cn 03 <br /> LICENSE APPROVED BY DATE: <br /> LAND SERVICES OFFICIAL CD w w <br /> � o <br /> Page 1 of 3 <br /> Burnett County, WI Short-Term Rental License Application—Rev 11/2024 <br />