HomeMy WebLinkAbout25-0236• Et 11Po sox 403 t B- z(FIELD
Washburn, WI 54891
(715)373-6109
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Short -Terns xentailication Packet
Health
Zoning
Submission Al
S —Q7
Fee Paid
Refund
Permit N
Date Issued
This application packet contains information fora Sliort-T6rr141fental permit through Bayfield County Planning and
Zoning Department. Completed application can he mailedlemailed to the address/email above.
SECTION A: ESTABLISHMENT INFORMATION
Establishment Name
Establishment Tax ID #
Town/City of
r
39't/2
Gr
jLK
Estab Street Address CityS
Zi
C id /v
/ '
W I
SECTION B: OWNER INFORMATION
Pr perty Owner Email 1r'c:::,:
Phone Number
i4/ D�jnnIt %
`/ 1/ //99
Owner Mailing Address y
State
Zip
132z tao;, r 3� . ' 4 tit
S3/S/
SECTION C: IF OPEKATING 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) !Tmrd h..t:oress
Phone Number
Agent Street Address r ity
State
Zip
SECTION D: RENTAL UNIT INFORMATION (see key below,
Unit Unit ID Structure Heating Water Sanitary Source
# of Stories L of
9 of
Type Source Source
Bedrooms
Bathrooms
et
zirc.it
('e/1
1oRun,t�zw,
A
H
2
2
3
4
Structure Type:
House H Duplex (D) Cabin (C) Yurt Y Apartment (A) Condo CO Other (O). please describe
Heating Source:
Electric (E) Natural Gas G Propane P Wood Fuel (F) Other (O), please
describe
Water Source: Sanitary Source:
Public/Municipal Private Well (P) Public/Municipal ) Private Onsite Wastewater System (P)
Scanned with
i M CamScanner
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I I MAR 1 3 2025 Ii?)
Rayfield Co. Zoning Dept
AFFIDAVIT OF AUTHORITY
(Corporation, LLC, etc.)
PURPOSE. This Affidavit of Authority is used to certify the individual submitting an application 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: "163 `(S c [c1( Syfr.Z
2. The Subject Property is owned by: ikt.i'na k a 13 ! L C
(Name of Company)
3. The name(s) of the current President or Managing Member:1OGPC( D rofyr n
4. I 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 submit an application to 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 Company to apply for and bind the Company to the terms
and conditions of any decision or permit issued by the Bayfield County Zoning Department.
6. 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.
Dated: 3f3 rldLS
U!;/C.P DPin c
Print Name
Subscribed and sworn to before me this
day of &CC . 2026.
No ary Publi , County, Wisconsin
My commission:
Land Use Permit Application Review Checklist
Submission #: 5TIQ.— OD135
Tax ID: 3't a
S -T -R: 55- y' — ®%
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 No
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:
'RYes O 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)?
'es ❑ No
Is the project located in the Floodplain?
Zone:
Yes ❑ No
Are there wetlands on the property?
❑ Yes No
Is project associated with a nonconforming use or structure?
Yes ❑ No
Does the project require sanitary?
Sanitary Permit #: 22'22 -1 -1 -IS Public System:
# of bedrooms:
'%Yes ❑ No
Does the project require an affidavit?
Affidavit #:
Number of Units:
Number of Bedrooms: `(
Number of Bathrooms:
Number of Stories: a
❑ After -the -Fact (ATF)
ATF Fee Amount:
Inspected by:
Date of Inspection:
Inspection Notes:
a-1-aaO1
Re -Inspected by:
Date of Re -Inspection:
Denied by:
Date of Denial:
Reason for Denial:
Date Denial Letter Mailed:
Approved by: V5 ; \ \
Date of Approval: 5 J `� C as
J IX
J Iv Cyr �/�
C�v\V `J c 1
lQ J
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.
5
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 ,Floodplain,Wetlands
LAND USE — X (previous permit 24-0207)
SANITARY - 22-177S
SPECIAL A —
SPECIAL B/CONDITIONAL —
BOA —
No. 25-0236 Tax ID: 38642
Issued To: DEJNO, TODD (NAMA KNB LLC)
BAYFIELD COUNTY
PERMIT
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
Location: S35 - T44N - R06W
Town of
Legal Description: LOT 2 CSM #2199 IN V.12 P.429 (LOCATED IN GOVT LOTS 3 & 4) TOG WITH EASE IN DOC 2022R- 593299
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 8 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.