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• <br /> ADDITIONAL PROVISIONS <br /> • FAILURE TO COMPLY WITH ANY OF THE BURNETT COUNTY CODE OF ORDINANCES MAY RESULT IN <br /> IMMEDIATE REVOCATION OF THIS SHORT-TERM RENTAL LICENSE,WHICH WILL CONSTITUTE AS A <br /> CEASE AND DISIST ORDER. <br /> • THIS LICENSE WILL EXPIRE ON THE DATE AS SHOWN ON PAGE 1. <br /> • BY SIGNING BELOW,OWNER AGREES TO ABIDE BY ALL SHORT-TERM RENTAL LICENSING <br /> REQUIREMENTS <br /> • THIS APPLICATION CONSTITUTES NOTICE THAT ALL IMPROVEMENTS ARE SUBJECT TO ACCESS AND/OR <br /> REVIEW BY THE LOCAL MUNICPALITY'S TAX ASSESSOR FOR THE PURPOSE OF TAX ASSESSMENT. <br /> I (owner) declare that this application (including any accompanying materials) has been examined by me, and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information <br /> contained in this application (including any accompanying materials), and I further declare that I recognize that this information <br /> provided will be relied upon by Burnett County in determining whether or not to issue a license. I accept all liability that may be a <br /> result of Burnett County relying on the information I am providing in this application. I acknowledge that I will abide by all <br /> private/public covenants,restrictions,leases and easements which may apply to this parcel. I agree to permit county officials charged <br /> with administrating county ordinances or other authorized persons to have access to the above-described premises at any reasonable <br /> time for the purpose of inspection. <br /> ---ADDITIONAL COMMENTS FROM OWNER ALLOWED HERE--- <br /> OWNER'S SIGNATURE: 7fq1/4 /t> 3 2S/20 2 y <br /> (DATE) <br /> Property Owner is required to sign and date this application. <br /> SUBMIT COMPLETED APPLICATION,MATERIALS,AND FEE TO: <br /> BURNETT COUNTY LAND SERVICES <br /> 7410 COUNTY ROAD K,#120 <br /> SIREN,WI 54872 <br /> APPLICATIONS WILL BE ACCEPTED VIA USPS,ANY STANDARD COURIER,OR IN PERSON. PARTIAL OR INCOMPLETE <br /> APPLICATIONS WILL BE RETURNED TO THE APPLICANT.NO EMAIL OR FAX APPLICATIONS WILL BE ACCEPTED. <br /> ONLY CHECK,MONEY ORDER OR CASH PAYMENT WILL BE ACCPETED. CREDIT OR DEBIT CARDS ARE NOT ACCEPTED <br /> AT THIS TIME. PLEASE,MAKE CHECK PAYABLE TO: BURNETT COUNTY LAND SERVICES <br /> Please call the Land Services Department if you have questions. 715-349-2109 <br /> Burnett County,WI ordinances can be found at: https://www.burnettcountvwi.gov/1043/County-Ordinances <br /> Page 3 of 3 <br /> Burnett County, WI Short-Term Rental License Application—Rev 12/2023 <br />