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CA a r r+ <br /> SHORT-TERM RENTAL LICENSE APPLICATION—Burnett County, WI 0 <br /> LA4" <br /> Applicant Complete All Sections Below This Line °. <br /> a 9 <br /> ar <br /> Original License Fee= $300 Renewal License Fee(Annually)=$150 \� <br /> Property Owner's Name:37 0 (vel tel— / y <br /> Property Owner's Mailing Address;D 'lei ----Liv-9g,. T ia L e/u_ if-1,1/2-' ) .) b <br /> ,�NN <br /> City State Zip <br /> Property Site Address: �kG ^i i2C -F .S LAD-! D c <br /> /- W <br /> C� <br /> Applicant's Telephone Number: 6/ 33 r• q `fdD 8o <br /> Zi <br /> Applicant's Email: U 1�' . I r7 i O`1 et It 0 O r a e_QS'.- /1 a-, I. :; <br /> UIt- <br /> /Legal Description of Property: O 0-3? a (40-- ILA-0 7-S /$ 7/1- o/'z CC/i ° C7 b <br /> Section#: t-q- Town#: 1() i N Range#: I f W Town of: S G'o T <br /> g. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property poe..** W <br /> l,Taac ID#(1-5 digit number;found on tax statement): /9 3 ? a 4 o ! <br /> 5 07/f ,ide !cam) c-t 1'7 Provide Rental Information &,or 11_r_ <br /> �1� i ' K ge f �„ <br /> LvT g � .-pi,� 4'21/( 7 ! r <br /> License Year App ped For: a C Amount of Renters Applied For: D ,5 . <br /> \ / i I Z3 ?AZA <br /> Local Contact's Name: V`y',t n t ate, 0 l e_ 11 . <br /> Local Contact's Address: Va 0 0�a 'v �S/62,,a o <br /> City State Zip <br /> Local Contact's Telephone Number: lob/ ,33 9 ft)) /t6/ I J G � <br /> Most Recent Burnett County License Number: STR- State License Number: I 1 Ge i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY y y d <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: n <br /> Thi / ► 5e- e-qI k-S 6'n V C7✓1 P, 2oZ i. --0 <br /> No/ IT e s/ Pt sq "'/ z w <br /> t <br /> V\ <br /> ,_. ily,c... Iy- by 6/i/azo. <br /> S 17176 1,,,,?4-4;t4 Me_. 7.0 f71- /Sx. eillet7c/i <br /> bnuns t r Fee Rec: <br /> 1r `/ <br /> "Le /1C(1 vt e f N ST4�/� off S C��� H, - �� �o///2_, Z��am <br /> 74 <br /> Date of staff site visit: I 3 (2 Initials of site visit staff: <br /> /) to <br /> LICENSE APPROVED BY DATE: 3 7 lit/Zd aC�, <br /> LAND SERVICES OFFICIAL o <br /> tz <br /> clo,co A <br /> C <br /> � � p <br /> Pagelof3 d(Dc = <br /> Burnett County,WI Short-Term Rental License Application—Rev 1/2019 g m <br /> 5 <br />