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Home My WebLink About25-0252�.IA117E 6a Street MAR I no %02'.1 Health ning PO Box 403 FIELD Submission# Washburn, WI 54891 Fee Paid (715) 373-6109 D f{ M (5 Refund permits@bayfieldcounty.wi.gov 6 6 U 6fi) Permit# lfi MAR 2 0 2025 Date Issued Shol y m%.9p k4;pplication Packet This application packet contains information for both a Tourist Rooming House license through Bayfield County Health Department and a Short -Term Rental permit through Bayfield County Planning and Zoning Department. Completed application and applicable fees can be mailed/emailed to the address/email above. City of Washburn, City of Hayfield, Town of Pilsen: License through Bayfield County Health Department is required. Please review and fill out pages 1-4. All Other Towns: A license through the Health Department and permit through the Planning and Zoning Department are required. Please review and fill out pages 1-5. SECTION A: ESTABLISHMENT INFORMATION Establishment Name The 'ocieLinc, I go it Establishment Tax ID # Tpwn/CityJ of 215g"1 NG_ _ilu ' 0tA City Stat ZIP C�:F�le w I Establishment Street Akddress H► -1B90 Ccuvlt Hvv D SECTION B: OWNEIL INFORMATION Property Owner u per ec t L -sae Email Address om �Cummermasonr .CW Phone Number 5L3 5w- U9 Owner Mailing Address i\\ She, City Dab State ZIP 5i9oo __ 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 a plicable) u.1Liefl \ Email Address rtyrsta\s @*bi4nrWtvTwi4 J Phone Number `l t -le3t C) Agent Street Address � a3,wactmeew4Q City State ZIP Ji 5' - SECTION D: RENTAL UNIT INFORMATION (see ke below Unit Unit ID Structure Type Heating Source Water Source Sanitary Source # of Stories # of Bedrooms # of Bathrooms ( / y 2 3 4 Structure Type: House Duplex Cabin C Yurt m Apartment (A) Condo CO Other (O), please describe Heating Source: Electric E Natural Gas G Propane Wood Fuel Other (0), please describe Water Source: Sanitary Source: Public/Municipal (M) 'iC Well Public/Municipal vale O ti zi'te Wastewater S Site Plan Show location of: F . Driveways l Frontage Roads (include name) CA Existing Structures 0 Well (W) a Septic Tank (ST) 14 Drain Field (DF) W Holding Tank (H7) fl. Lake ❑ River ❑ Stream/Creek O Pond O Floodplain ❑ Wetlands O Slopes over 20% 0 N Lo e, MAR 202025 �I Bayfielo Co. Zoning Dept. Cpcn ✓r6A e` 1 , Lvu 1` C Setbacks from furthest extent including eaves and County Use Only overhangs of structure to: Verified setbacks Road Centerline 57 ft R Notes/Comments: Front Lot Line/Right-of-Way R ft Side Lot Line I 3p ft ft oNt t❑South❑West check one) Side Lot Line 2 ' ft ft or CJEastfjSouthl]West❑checkone )tear Lot Line ft R Septic/Holding Tank r ft ft Drainfield ft ft Privy ft ft. Well ft ft Existing Struclure/Building ft. ft Wetland ft ft Elevation of Floodplain ft ft Ordinary High -Water Mark (OHWM) ft ft nun: riease indicate —see attached" on this page if submitting site plan as a separate document. Bayfield County Health Department — State Lodging License Health Department (State Lodging License): All rental units require a Tourist Rooming House license through the State of Wisconsin Department of Agriculture, Trade and Consumer Protection (WDATCP) or their authorized agent (Bayfield County Health Department. > Bayfield County Health Department issues permits on behalf of the State of WDATCPrRpd AIJXIIP p2 78 and 79. G u liii ➢ ATCP 72 regulates lodging facilities including hotels, motels and tourist rooming hous aa MAR 2 0 2025 > Bayfield County Ordinance Title 9 — Chapter 2 Food Protection, Lodging, Pools, Camp r50ia Co. Zoning Dept. Recreational/Educational Camps. Tattoo and Body Piercing Establishments outlines the licensing program and the authorized agent agreement between the Bayfield County Health Department and the State of Wisconsin. > ATCP 72.03(20): "Tourist rooming house" means all lodging places and tourist cabins and cottages, other than hotels and motels, in which sleeping accommodations are offered for pay to tourists or transients. It does not include private boarding or rooming houses not accommodating tourists or transients, or bed and breakfast establishments regulated under Ch. ATCP 73. > Wis. Stat. § 97.67 (5) and § 97.605 (1)(c) "No license may be issued until all applicable fees have been paid." > Wis. Stat. § 97.605 (1)(a) "No person may conduct, maintain, manage or operate a hotel, restaurant, temporary restaurant, tourist rooming house, vending machine commissary or vending machine if the person has not been issued an annual license by the department or by a local health department that is granted agent status under s. 97.615 (2)." > Within 30 days after receiving a complete application for a license, the department or its agent shall either approve the application and issue a license or deny the application. If the application for a license is denied, the department or its agent shall give the applicant reasons, in writing, for the denial. > A license shall not be issued to an operator without prior inspection. > Tourist rooming houses license expires on June 301. ATCP 72 requires an annual renewal application and fee. Failure to maintain proper permitting will result in penalties. Licenses are non -transferable, except to immediate family members as allowed in ATCP 72. APPLICATION FEES — Required for all tourist rooming house within Bayfield County Check or money order payable to Bayfield County Health Department When will your rental be in operation: ❑ Summer ❑ Winter [Wear -Round ❑ $575 — License Fee ($275) + Pre -Inspection Fee ($300) Pre -Inspection Fee includes bacteriological sample analysis for private drinking water supply. ❑ Rush Fee ($50) — A one-time $50 rush fee will be charged for inspections requested within 7 business days. However, depending on scheduling, staff may not be able to accommodate all rush requests. Your signature below will acknowledge you have received information as to where to obtain a copy of the code and will comply with applicable Wisonsin Administrative Code(s). Personally identifiable information you provide may be used for pumose's'other then thl for which it was colle U ted Wis,, tat. § 15.04 (1 m)). Signature: % Date: Bayfield County Planning and Zoning Short -Term Rental Permit PLANNING AND ZONING QUESTIONS 1. Is the property in the shoreland, within 300 feet of a river/stream OR landward side of floodplain OR 1000 feet of a lake/pond/flowage, whichever is greater? 0 Yes O No O Unsure 2. Is there a wetland located on the property? ❑ Yes O No O Unsure 3. Is therea flood lain located on or near the ? ❑ Yes ❑ No ❑ Unsure 4. Is this project associated with any of the following: 0 Rezone 0 Conditional Use 0 Special Use ❑ Variance 5. Did you contact the town to see if any ermits/r uirements apply to your project? O Yes O No Zoning Department Use Permits: Short -Term Rental permits through Bayfield County Planning and Zoning Department are non -transferable, except as per the exemptions identified in ATCP 72.04(3). Short -Term Rental permits are regulated by Bayfield County Ordinance Section 13-1-35. APPLICATION FEES Check or money order payable to Bayfield County Planning and Zoning I unit: $500 2 unit: $1,000 3 unit: $1,500 4 unit : $2,000 To ensure your application is complete and can be processed by the Department, check you have the following items: 0 Applicant Information (Page 1) IIJI I! [ V E ❑ Site Plan(Page 2) MAR 202025 U ❑ Floor Plan(s) — Provide sheet for each floor within each unit. ❑ Fees paid Bayfield Co. Zoning Dept. I (we) declare that this application, including any accompanying information, has been examined by me (us) and to the best of my (our) knowledge and belief it is true, correct, and complete. I (we) acknowledge that I (we) am (are) responsible for the detail and accuracy of all information that I (we) are providing and that will be relied upon by Bayfield County in determining whether to issue a permit. I (we) further accept liability which may be a result of Bayfield County relying on this information I (we) are providing in or with this application. I (we) consent to county officials charged with administering county ordinances to have access to the above-descri d property at any reasonable time for the purpose of inspection. 1 Owner(s) or Authorized Agent Printed Name: Owner(s) or Authorized Agent Signature: er-' Date: .3'-/Y NOTE: If you are signing on behalf of the owner(s) a letter of authorization must accompany this application. BAYFIELD COUNTY HEALTH DEPARTMENT P YFF'IETJ) License, Permit or Registration The person, firm, or corporation whose name appears on this certificate has complied with the provisions of the Wisconsin statutes and is here by authorized to engage in the activity as indicated below. ACTIVITY EXPIRATION DATE I D NUMBER Tourist Rooming House (LTR), Rooms: I 30 -Jun -2025 MSIE-C67N3P CUMMER REAL ESTATE 11921 SHERRILL RD DUBUQUE IA 52002 THE YODELING LOON 44890 COUNTY ROAD D CABLE WI 54821 ill MAR 202025 Bayfield Co. Zoning Dept. All Permits expire on June 30th; it is the responsibility of the licensee to make sure the license renewal and all applicable fees be POSTMARKED BY JUNE 30TH or a late payment fee will be assessed. Visit our website We have a link to pay via credit card' please note there is a fee for this on-line service It you do not receive a renewal form prior to June 30th trom your licensing authority, you should send in your payment for renewing your permit to the following address: BAYFIELD COUNTY HEALTH DEPARTMENT PO BOX 403 WASHBURN. WI 54891 (715)373-6109 * Include the name of your facility and the ID number. F-fd-123 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 u 1. Address of Subject Property: L) Li Lt Ct,ur t+y 11 W V 1) , 0 C kjU Z s'') $ a 2. The Subject Property is owned by: Cunlnlet rG I , LLQ (Name of Company) 3. The name(s) of the current President or Managing Member. I C -nn lJeAtr„ne bO J(l @Ur71n12 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. 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 permit that may be issue 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 for permit. Dated: Subscribed and sworn to before me this c" day of N)o 20c Notary Public, County, Wissensnlo�. My commission: - -'11 ALECIA KRAMER qL Commission Number 760370 My Commission ExpireslowA 10/09/2027 Land Use Permit Application Review Checklist Submission #: 5 - O0 `1 Tax ID: 2 `i S 8y S -T -R: f/—g3--b(o What zoning district is the project located in? 1 ❑R-2 ❑R-3 ❑R-4 DR-RB ❑C ❑I ❑M ❑A-1 ❑A-2 ❑F-1 ❑F-2 ❑W DM -M 9Yes ❑ No Does lot meet the zoning dimensional requirements or is it substandard? Deed of record: YYes ❑ 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 'YVo 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 structue? Yes ❑ No Does the project require sanitary? Sanitary Permit #: 21- 1'L0 S Public System: # of bedrooms: 5j Yes ❑ No Does the project require an affidavit? Affidavit #: Number of Units: 1 Number of Bedrooms: Number of Bathrooms: 3 Number of Stories: O After -the -Fact (ATF) ATF Fee Amount: Inspected by: d es; � Date of Inspection: r37 5 Inspection Notes: L I —Y\O IS5U-t Re -Inspected by: Date of Re -Inspection: Denied by: Date of Denial: Reason for Denial: Date Denial Letter Mailed: Approved by: N\�w1�S Date of Approval: G _ _ c1 C' O ( 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. I Short -Term Rental is for a maximum occupancy of y persons. ❑ Additional conditions may be placed and need to be adhered to at the time of permit issuance Other Conditions: P YFIELD I 1• LD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: CUMMER REAL ESTATE LLC 11921 SHERRILL ROAD DUBUQUE, IA 52002 Description 1 unit Submission Number: STR-00144 Transaction Number: STR-00144-2AB15 Amount $500.00 Total: $500.00 Payment Amount: $500.00 Reference: 002832 Paid by: Cummer Real Estate Payment Type: Check Transaction Date: undefined Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. Town, City, Village, State or Federal Permits May Also Be Required Shoreland ,Substandard LAND USE -X SANITARY - 21-140S SPECIAL A - SPECIAL B/CONDITIONAL - BOA - BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION No. 25-0252 Tax ID: 24584 Issued To: CUMMER REAL ESTATE LLC Location: S11 - T43N - R06W Town of Legal Description: LOT I CSM #982 V.6 P.248 (LOCATED IN GOVT LOT 3) CUMMER REAL ESTATE LLC 381D 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 10 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 08, 2025 This permit may be void or revoked if any performance conditions are not completed or if any prohibitory conditions are violated. Date