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SHORT-TERM RENTAL LICENSE APPLICATION — Burnett County, WI r r <br /> Applicant Complete All Sections Below This Line <br /> Original License Fee=$300 Renewal License Fee(Annually)_$150 I a <br /> d � <br /> Property Owner's Name: Gf t'W <br /> Property Owner's Mailing Address: 5 t o I C A x Ave- e PQI I S <br /> City State Zip <br /> Property Site Address: �yS.6U (r• o,7) Pa.,+ �opd WfhS�(I^ 1� i S�I�°I� c <br /> Applicant's Telephone Number. <br /> Applicant's Email: (2f 1`4 P.- i'r'o1i (u,V\ <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: @BurnettCountyWI.gov <br /> loE <br /> Legal Description of Property: Ll S \N Gov 5 ("a-iS � a <br /> Section#: S U -k Town#: 13a N Range#: R 5N^ W Town of: L A f 0 i tat <br /> kt N ^� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number,found on tax statement): <br /> Provide Rental Information <br /> License Year Applied For: ,t 0 A� Amount of Renters Applied For: <br /> Local Contact's Name: ►l 0 1 f �K f,S N6 GAS <br /> Local Contact's Address: a L�S b y tr M-C ) VJ O>5kf r W) <br /> City State Zip �[1 <br /> Local Contact's Telephone Number: '3 b�" �2a 0 -rC(J'o09 <br /> Most Recent Burnett County License Number: STR- 23 72^ State License Number: CP <br /> t � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o d <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: y <br /> Q (S Inc-ev�Se ter 2�Zy �- 2025. o z o.� <br /> (door + 1�-V\A 0 (fit ine,S <br /> P l ac�curd new- mc� n � � <br /> to be ope-t�ed Lk)t n �Lwtvv� t�occLl C6 A.+tc,+ PlN�i S Li'CehS <br /> -, Fee Rec: <br /> nu mar + cULAt Ucevo% OLX Mbr✓►- Ck#:��y� <br /> z <br /> 0 l� all LAC_tInSt l� Y-e(,u,� 1%e vl�e�FS. M Z-l? <br /> 14, <br /> Date of staff site visit: 12 ZOZ`/ Initials of site visit staff- <br /> m <br /> - <br /> LICENSE APPROVED BY DATE: C'" �- <br /> mW <br /> LAND SERVICES OFFICIAL <br /> m CD <br /> N <br /> 0 o <br /> Page 1 of 3 _0 ^�' <br /> Burnett County,WI Short-Term Rental License Application—Rev 12/2023 � <br /> CD <br />