HomeMy WebLinkAbout25-0092117 E 6" Street
PO Box 403
Washburn, W154891
(715)373-6109
ermits a ba fieldcounty.wi.go
A
�1 $ YFIELD
Emig
FE8 0 4 2025
Health
Zonin
Submission #
Fee Paid
Refund
Permit #
-004
Date Issued
WUM
B4§6cftlf erl�n itental Application Packet
This application packet contains information loi a Short- form Rental permit through Bayfield County Planning and
Zoning Department. Completed application can be mailed/entailed to the address/email above.
SECTION A: ESTABLISHMENT INFORMATION
Establishment Name
r�
Establishment Tax ID #
CIO - 9 uc,
Town/City of
Sw n t t'*-k
Establishment Street Address
5 5� r7` ao&
City
rP17 kI w7
State Zi
W I -
SECTION B: OWNER INFORMATION
Property Owner I
Vaal d lna-m L e-&
Email Address
,� r/
� t q r LtJ�Wni Itxvlcl hG
Phone Number
�/ Sa X -/53 0
Owner Mailing Add ess /
/5613a 5CCY! i r-
Ci
State
Zip
SS36�-
SECTION C: IF OPERATING WITH PARTNER OR AGENT
Legal Licensee (partnership, I,I.C, it or Inc.)
Email Address
Phone Number
Licensee Street Address
City
State
Zip
Agent Name (if applicable)
Email Address
Pltone umber
Agent Street Address
City
State
Zip
SECTION D: RENTAL UNIT INFORMATION see key
below
Unit
Unit ID
Structure
T e
Heating
Source
Water
Source
Sanitary Source
# of Stories
# of
Bedrooms
# of
Bathrooms
%
3
4
Structure Type:
House H Duplex D Cabin C Yurt Y Apartment A Condo CO Other (0), please describe
Heating Source:
Electric E Natural Gas G Propane P Wood Fuel F Other (0), please describe
Water Source:
Public/Municipal M Private We11 P
I Sanitary Source:
Public/Municipal M Private Onsite Wastewater System P
AFFIDAVIT OF AUTHORITY
(Corporation, LLC, etc.)
PURPOSE. This Affidavit of Authority is used to certify the individual applying for a permit is authorized
when the property is owned by a corporate/business entity.
STATE OF WISCONSIN )
) ss.
BAYFIELD COUNTY )
The undersigned affirms and states as follows:
1. Address of Subject Property: 5 a � 7�rT k4e Wd- .Iran 6t" j
2. The Subject Property is owned by:-4 r�- Lk, �rvQ_-r'�4 I ) L'
an (Name of Compy)
3. The name(s) of the current President or Managing Member:
S-6 QT yi e � rc,/ .
4. 1 certify that the company named in paragraph 2 is valid and in effect on the date signed below. I
am the duly appointed agent of the Company named above in paragraph 2, and I have the
authority under the terms of said authorization to apply for permits from the Bayfield County
Zoning Department concerning the Property described in paragraph 1. 1 further certify that the
information and statements made within this affidavit are true, accurate, and complete to the best
of my knowledge.
5. 1 am authorized by the above -named Company to apply for and bind the Company to the terms
and conditions of any permit that may be issue by the Bayfield County Zoning Department.
6. By signing this affidavit, 1 attest that I am unaware of any known or unknown person(s) who would
contest this application. I agree to indemnify Bayfeld County or such person or legal entity
suffering a damage resulting from any illegalities of the application for permit.
Dated: 3 ' 5-
z�r
Print Name
Subscribed and sworn to before me this
day of
'Notae�Pubf , Co nty. W+econsin
My commiss
DA1, ROBIN lAN7(
+ NOTARYWatIC
STATE O<MINNESOTA
ihne�
Land Use Permit Application Review Checklist
Submission #:5712-000(p4-j
I Tax ID:
S-T-R: 2 7- `17-0&
What zoning district is the project located in?
R-1 ❑ R-2 ❑ R-3 ❑ R-4 ❑ R-RB ❑ C ❑ I ❑ M ❑ A-1 ❑ A-2 ❑ F-1 ❑ F-2 ❑ W ❑ M-M
❑ Yes i,% No
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:
l Yes ❑ No
Is the project located in the Shorelands (Shorelands are lands within 300 feet of a river/stream OR
landward side offloodplain OR 1000 feet of a lake/pond/flowage, whichever is greater)?
❑ Yes 1g'No
Is the project located in the Floodplain?
Zone:
❑ Yes No
Are there wetlands on the property?
❑ Yes XNo
Is project associated with a nonconforming use or structure?
Yes ❑ No
Does the project require sanitary?
Sanitary Permit #: 114-102-S Public System:
# of bedrooms: 3 / 1550 5c �L
,Yes ❑ No
Does the project require an affidavit?
Affidavit #:
Number of Units: j
Number of Bedrooms: Y
Number of Bathrooms:
Number of Stories: 1
❑ After -the -Fact (ATF)
ATF Fee Amount:
Inspected by:
I eSi ���(,a�nS'C,(
Date of Inspection:
Inspection Notes:
—pvtV�uO,S perm�1�.lq-1893'-1
1,
-Pw�rra- CI.�� � r1Gr'Ic jrnF-t. �in���
U
Re -Inspected by:
Date of Re -Inspection:
Denied by:
Date of Denial:
Reason for Denial:
Date Denial Letter Mailed:
Approved by:
Date of Approval: �- I �^ ^S$-
OD°I
Condition(s):
PFown/State/DNR/Federal may require permitting
❑ This permit cannot be transferred if property is sold.
❑ A Bayfield County Health Dept permit is required.
❑ Check with Town regarding room tax. r_
�hort-Term Rental is for a maximum occupancy of G persons.
❑ Additional conditions may be placed and need to be adhered to at the time of permit issuance
Other Conditions:
Town, City, Village, State or Federal
Permits May Also Be Required
Shoreland
LAND USE —X (previous 14-0434)
SANITARY—14-102S
SPECIAL A —
SPECIAL B/CONDITIONAL—
BOA —
No. 25-0092 Tax ID: 19766
Issued To: GEARY, STEPHANIE & DAVID
BAYFIELD COUNTY
PERMIT
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
Location: S27 - T47N - R08W
Town of
Legal Description: PAR IN GOVT LOT 5 IN V.1160 P.408 545C
Residential Structure in R-1 zoning district
For: [1-Unit] Short -Term -Rental
(Disclaimer): Any future expansions or development would require additional permitting.
Condition(s): Town may require permitting. Short -Term Rental is for a maximum occupancy of 6 persons.
NOTE: This permit expires two years from date of issuance if the authorized construction Desi Niewinski
work or land use has not begun.
Authorized Issuing Official
Changes in plans or specifications shall not be made without obtaining approval.
This permit may be void or revoked if any of the application information is found
to have been misrepresented, erroneous, or incomplete. March 17, 2025
This permit may be void or revoked if any performance conditions are not Date
completed or if any prohibitory conditions are violated.