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SHORT-TERM RENTAL LICENSE APPLICATION - Burnett County, WI <br /> A+ s r t•" <br /> Applicant Complete All Sections Below This Line a o <br /> c CID,// <br /> 17 Original License Fee=$300 M enewal License Fee(Annually)_$150 g _ <br /> Property Owner's Name: �Ak) �1 d►Yl1(1 ��. le <br /> G u �s <br /> Property Owner's Mailing Address: �c 3G O� S W 1 5 1 Lrn <br /> _ j City State Zip. <br /> Property Site Address: 2�12 LAOSe 4 nt( P SS 06-d SDGOYV-"�- W1 Ea gu I ~ <br /> Applicant's Telephone Number: -1 b-2 SS U- to <br /> Applicant's Email ec \eC re Sk«✓ G . " C _ Mnn <br /> **If staff has a question a ut this application,yo'hJwill be bdntacted via email. Make sure your email address is C <br /> legible and your email provider will accept emails from the following address: 6V1 <br /> @Bume <br /> Legal Description of Property: P(L. C c5m V1 ;Pu) C10i uy�a\1 r <br /> o � <br /> Section#: _Town#: N Range#: W Town of. <br /> *.Attach.additio.ra?,Wage y'reeded for.tergth;�descriptior OR,attach a coPy of the deed OR attach tax system property page.* �— <br /> Tax ID#(1-5 digit number;found on tax statement): K 59 Z(0 o <br /> � � N <br /> A <br /> Provide Rental Information ° <br /> 2 02 T Amount of Renters Applied For: ' <br /> License Year Applied For: pp <br /> Local Contact's Name: R- <br /> i i c <br /> Local Contact's Address: N ` % 1 r�l� L A�kD VA ._7D kf 1h�1 Sy l N o <br /> �'_�, ity State Zip N N <br /> Local Contact's Telephone Number: i `�"1 I — "fit x N <br /> Most Recent Burnett County License Number: STR- 22s-4'S`i State License Number:hTC PP-ol 3�3Z m J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o W <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> © LtCev1S� �r�S (`3 l-2o2(n <br /> A W <br /> C+1 <br /> rA <br /> nCeu av�C� -t atlas +&M � s n& fio zcc eed � N <br /> oz z <br /> 3� &,tk es l4Ca,r4 tob�v a-�e� e�r�tn I'�lSSi�5 I►� orma i -c <br /> (5p,& <br /> R kal id�l�v��s 5lnedr(�, 1,�� n h 5• A{�o fee LclteY d <br /> Fee Rec: (5 0.00 <br /> ll k �� 1�c r e U.t�'2rnP,v � by Ck#: <br /> m <br /> z <br /> m <br /> Date of staff site visit: O a O 6o S Initials of site visit staff: �1 T+ L9 <br /> m !� <br /> cf) <br /> LICENSE APPROVED BY L DATE: �— <br /> m cn <br /> LAND SERVICES OFFICIAL CD <br /> � n <br /> o c _' o <br /> Page 1 of 3 <br /> Burnett County,WI Short-Term Rental License Application— Rev 11/2024 � LA <br />