HomeMy WebLinkAbout25-023417 E 6th 1 PO Box 403 et $-=YFIELD
Washburn, WI 54891•
(715)373-6109
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permits(a�bayfieldcounty.w i
JAN 1 a 2or5
Health
Zoning
Submission #
Fee Paid
Refund
Permit #
Date Issued
Bavfield Co Zonin Dept.
Short -Term Rental Application Packet
This application packet contains information for a Short -Term Rental permit through Bayfield County Planning and
Zoning Department. Completed application can be mailed/emailed to the address/email above.
SECTION A: ESTABLISHMENT INFORMATION
Establishment Name
Estaj,Iishinent Tax ID #
Town/City of
P_V)evie 4rgqe
Establishment Street Address
Ci S to
Zip
s _
yea
SECTION B: OWNER INFORMATION
Property Owner
Email Address .
Phone Number
I�.VN
j9mr.ksVeJ4xxALlTi
5251 2 9- Jii (0
Owner Mailing Address
City
State
Zip
Zt;m_
M N
559ga-
SECTION C: IF OPERATING WITH PARTNER OR AGENT
Legal Licensee (partnership, LLC, LLP, or Inc.)
Email Address
Phone Number
Licensee Street Address
City
State
Zip
Agent Name (if applicable)
Email Address
Phone Number
Agent Street Address
City
State
Zip
SECTION D: RENTAL
UNIT INFORMATION (see Ice
below)
Unit
Unit ID
Structure
Heating
Water
Sanitary Source
# of Stories
# of
# of
Type
Source
Source
Bedrooms
Bathrooms
___fcview
C
P
2
3
4
Structure Type:
House (H) Duplex Cabin (C) Yurt Apartment (A) Condo CO Otadescribeplease
Heating Source:
Electric (E) Natural Gas G Propane Wood Fuel Other O please
Water Source:
Sanitary Source:
Public/Municipal (M) Private Well P
Public/Municipal M Private Onsite W
AFFIDAVIT OF AUTHORITY
(Trust)
PURPOSE. This Affidavit of Authority Is used to certify the Individual applying for a permit is authorized
when the property is owned by a Trust,
STATE OF WISCONSIN
ss.
BAYFIELD COUNTY
The undersigned affirms and states as follows:
1. Address of Subject Property: I%t} 1 Cc\ blrtr ( -'Oc , v\! 1 gzig;.
2. The Subject Property is owned by: k.t _Kis\, r�� �nn (Is\-) KNXab'\ -t t'.ik
(Name of Trust)
3. The name(s) of the current Trustee(s): k(Mrn L. \IS\n
J�2nn,! D, Ktsh
4. I certify that the Trust named in paragraph 2 is valid and in effect on the date signed below. I am
the duly appointed agent of the Trust 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. I further certify that the information and
statements made within this affidavit are true, accurate, and complete to the best of my
knowledge.
5. I am authorized by the above -named Trust to apply for and bind the Trust to the terms and
conditions of any permit that may be issue by the Bayfield County Zoning Department.
6.
Dated:
By signing this affidavit, I attest that I am unaware of any known or unknown person(s) who would
contest this application. I agree to indemnify Bayfield County or such person or legal entity
suffering a damage resulting from any illegalities of the application for permit.
?rv' AAh�
Print N
WF
Subscribed and sworn to before me this
day of , 20�\
My
SUSAN M ECKER
NOTPRY PJ&E • MINNESOTA
8 MY CtkAMISSION E%PIF£S 01I31Y1
MinVleso'�"ti
Land Use Permit Application Review Checklist
Submission #: 579- occ 1 to
Tax ID: at z-! `-i -7 9
S -T -R: O`1 - y 3 -O fo
What zoning district is the project located in?
R-1 ❑ R-2 ❑ R-3 ❑ R-4 ❑ R-RB ❑ C ❑ 1 ❑ M ❑ A-1 ❑ A-2 ❑ F-1 ❑ F-2 ❑ W ❑ M -M
❑ Yes 1( No
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:
Yes ❑ No
Is the project located in the Shorelands (Shorelands are lands within 300 feet of a river/stream OR
landward side of floodplain OR 1000 feet of a lake/pond/flowage, whichever is greater)?
❑ Yes No
Is the project located in the Floodplain?
Zone:
V Yes ❑ No
Are there wetlands on the property?
Is project associated with a nonconforming use or structure?
Does the project require sanitary?
❑ Yes pNo
].Yes ❑ No
Sanitary Permit#: 131(03 Public System:
# of bedrooms: L ULLe'r s
o
Does the project require an affidavit?
I�
Affidavit #:
Number of Units: (
Number of Bedrooms: 3
Number of Bathrooms:
Number of Stories: I
❑ After -the -Fact (ATF)
ATF Fee Amount:
Inspected by:
Date of Inspection:
Inspection Notes:
_ eYe�/\0 Perm.:+ pri-oo5 u 1
CUyy& � 0t& P✓ 1 oZ
Re -Inspected by:
Date of Re -Inspection:
Denied by:
Date of Denial:
Reason for Denial:
Date Denial Letter Mailed:
Approved by: TOeC ' A � �\` c l
J t�J V� J
Date of Approval: C l 5-t;
J p(
Condition(s):
Town/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.
[�
Short -Term Rental is for a maximum occupancy of / 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 ,Wetlands
LAND USE — X (previous 09-0054)
SANITARY - 43163
SPECIAL A -
SPECIAL B/CONDITIONAL—
BOA —
No. 25-0234 Tax ID: 24479
Issued To: KISH TRUSTEES, KEVIN L & JENNIFER D
BAYFIELD COUNTY
PERMIT
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
Location: S09 - T43N - R06W
Town of
Legal Description: LOT 2 CSM VA P.279 (LOCATED IN GOVT LOT 3) IN V.1147 P.405 355F (KISH TRUST DTD 08/05/15)
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 4 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. May 06, 2025
This permit may be void or revoked if any performance conditions are not Date
completed or if any prohibitory conditions are violated.