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SHORT-TERM RENTAL LICENSE APPLICATION! — Burnett County, W1 <br /> � r <br /> � � A <br /> Applicant Complete All Sections Below This Line �. <br /> p <br /> 0 c <br /> ® Original License Fee=$300 Renewal License Fee (Annually) = 150 <br /> d � <br /> Property Owner's Name: 6r-Ag 5kc .e— /Y) iz L o° <br /> a <br /> Property Owner's Mailing Address: 3 7 tr L-_ OY►S �'v d <br /> City Stat j Zi <br /> Property Site Address: 2 6 5 � �o L © h en c�Li. S pauV, �J S`I 5.0 I o <br /> Applicant's Telephone Number: 7 2d D/#Z7 r tom, <br /> Applicant's Email: S e S f r r c+�'►/n r C ld�'✓� _\ <br /> **If staff has a question abou this application, ou will be contacted via email. Make sure your email address is k o <br /> legible and your email provider will accept emails from the following address: @BurnettCountyr go <br /> rtccf Et '� Y/o/ <br /> Legal Description of Property: Loi`z Cerf+G'le.� 'St,,rvr/ Maio !✓4 Z6!y <br /> d _l <br /> Section#: Town#: 3`� N Range#:—j4--W Town of: klv;V <br /> *Attach additiona/page ifneeded for lengthy description OR attach a copy of the deed OR attach tax system propertypal;e. <br /> 1571 -` I D ~ <br /> Tax ID#(1-5 digit number; found on tax statement): d o <br /> Provide Rental Information Q <br /> License Year Applied For: Z Amount of Renters Applied For: U <br /> m �1 <br /> Local Contact's Name: �Li ey+j�1\ 1�ci (-j2— <br /> Q <br /> ['// <br /> Local Contact's Address: PQ A_11 K 17 & naYw�k to 5y gk3 z <br /> City State Zip N o <br /> Local Contact's Telephone Number: -7/ 3 - D l <br /> H <br /> Most Recent Burnett County License Number: STR- Zq- State License Number: A T-r-P -D 53 5-7 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY G <br /> yT�nHIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: c y o <br /> OCCu Ct�wl �A"fiS& s nod- t� �-�Ceed g qat- f6 � o z <br /> z i <br /> San PO <br /> c5;e,��, �t.,r�, l.�d tv l��Cu�� tv rf� a. �pGl�. �C�'t4�r� �`� �-Z • . � -- <br /> C4) <br /> b� Ud tO Nrr&+ nu,�-n ��E OCCu ai-►ts <br /> I-�,�e�f� 2S try u.�a Imo, p � � <br /> t o � 'e- a( faC�'16'V1C'o�• Fee Rec:� <br /> o <br /> su <br /> Date of staff site visit: +t I� 2 Initials of site visit staff- OT + L8 o 1> M <br /> cn cm a) C= <br /> LICENSE APPROVED BY ftfj �. &A DATE: `► ��- �� m' <br /> m <br /> LAND SERVICES OFFICIAL o 0 r �' <br /> tv <br /> Page 1 of 3 `D <br /> Burnett County,WI Short-Term Rental License Application—Rev 11/2024 <br />