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Land Use Permit Application Review Checklist
Submission #: S'Tl2 -1005017
Tax ID: 3- B
S -T -R: 3j -St--o(
Town: bell
What zoning district is the project located in?
R-1 ❑ R-2 ❑ R-3 ❑ R-4 ❑ R-RB CCCI ❑ M ❑ A-1 ❑ A-2 ❑ F-1 ❑ F-2 ❑ W ❑ M -M
❑ YesXNo
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 10001feet of a lake/pond/flowage, whichever is greater)?
❑ Yes No
Is the project located in the Floodplain?
Zone:
❑ Yes No
Are there wetlands on the property?
es ❑ No
Is project associated with a nonconforming use o tructure. �G�✓�
Yes ❑ No
Does the project require sanitary?
Sanitary Permit/I#I: ) `�-6iiS Public System:
# of bedrooms:?-
❑ YesY No
Does the project require an affidavit? ❑ LLC ❑ Trust
Affidavit #:
Numberof Units: I
Numberof Bedrooms: 2
Numberof Bathrooms: /
Number of Stories: ]
❑ After -the -Fact (ATF)
ATF Fee Amount:
Inspected by:
I� \t\/SE
Date of Inspection:
-� - a
Inspection Notes:
— r -Y' q 1 ot{oJC
Re -Inspected by:
Date of Re -Inspection:
Denied by:
Date of Denial:
Reason for Denial:
Date Denial Letter Mailed:
Approved by:
tom; �`e��;rsci
Date of Approval:
1® -a1 -s
as -n
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 of0 persons.
❑ Additional conditions maybe placed and need to be adhered to at the time of permit issuance.
Other Conditions:
117 E 6'" Street
PO Box 403
Washburn, WI 54891
(715) 373-6109
permits( bavfieldcounty.wi. gov
Short -Term
P-LYFIELD
s(J
'
Health
Zonin
Submission' #.
''
3oD.
Fee Paid
Refund
Permit #
Date Issued
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 Hayfield County Planning and Zoning Department. Completed
application and applicable fees can be mailed/emailed to the address/email above.
City of Washburn, City of Bayfield, 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 naves 1-5.
SECTION A: ESTABLISHMENT INFORMATION
Establishment Name
SkyFire, LLC
Establishment Tax ID #
37902
Town/City of
Bell/Cornucopia
Establishment Street Address
19890 Mountain Ash RD
City
Cornucopia
State
WI
ZIP
54827
SECTION. B: OWNER INFORMATION l
Property Owner
Elisa Umpierre
Email Address
eliump2147@yahoo.com
Phone Number
507-251-3137
Owner Mailing Address
PO BOX 238
City
Cornucopia
State
WI
ZIP
54827
SECTIOS`'CfIF OPERATING WITH PARTNER
OR AGENT ", .- `
Legal Licensee (partnership, LLC, LLP, or Inc.)
**Site Plan on Record**
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 I): RENTAL UNIT INFORMATION see Ice
below - .
Unit
Unit ID
Structure
Type
Heating
Source
Water
Source
Sanitary Source
# of Stories
# of
Bedrooms
# of
Bathrooms
1
37902
H
NG
P
P
2
4
3.5
2
3
4
Structure Type:
House Duplex (D) Cabin (C) Yurt Apartment (A) Condo CO Other O please describe
Heating Source: '..
Electric (E) Natural Gas G Propane (P) Wood Fuel Other (O), please describe
Water Source:
Public/Municipal (M) Private Well P)
Sanitary Source:
Public/Municipal (M) Private Onsite Wastewater System (P)
1
Site Plan
Setbacks from furthest extent including eaves
overhangs of structure to:
Road Centerline
Front Lot Line/Right-of-Way
Side Lot Line 1
(NorthDEastDSouthDWestD check one)
Side Lot Line 2
orth❑East❑South❑West❑ check one
)tear Lot Line
Septic/Holding Tank
Privy
Well
Existing Structure/Building
Wetland
Elevation of Floodplain
Ordinary High -Water Mark (OHWM)
NOTE: Please indicate "see attached" on this
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
f
liii
ft.
ft.
ft.
ft.
ft.
fr.
ft.
ft.
ft.
ft.
ft
ft.
ft.
e if submitting site plan as a separate document.
2
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 WDATCP under ATCP 72, 73, 76,
78 and 79.
➢ ATCP 72 regulates lodging facilities including hotels, motels and tourist rooming houses.
➢ Bayfield County Ordinance Title 9 — Chapter 2 Food Protection, Lodging Pools Campgrounds,
Recreational/Educational Camps Tattoo and Body iercing 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 731
➢ 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 30'. 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.
l When will your rental be in operation:
1 ❑ Summer ❑ Winter H Year -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 Wisconsin Administrative Code(s). Personally identifiable information you provide may be
used for puoses oth an that for which it was collected is. Stat. § 15.04 (1)(m)).
Signature: Date:
06/25/2025
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 ❑ No ❑ Unsure
2.
Is there a wetland located on the property? ❑ Yes 1] No ❑ Unsure
3.
Is there a floodplain located on or near the property? ❑ Yes 1] No ❑ Unsure
4.
Is this project associated with any of the following: ❑ Rezone ❑ Conditional Use O Special Use
❑ Variance
5.
Did you contact the town to see if any permits/requirements apply to your project? 0 Yes ❑ 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
1 unit: $500 12 unit: $1,000 13 unit: $1,500 14 unit: $2,000
To ensure your application is complete and can be processed by the Department, check you have the following items:
El Applicant Information (Page 1)
O Site Plan (Page 2)
0 Floor Plan(s) — Provide sheet for each floor within each unit.
0 Fees paid
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 -described property at any reasonable time for the purpose of
inspection.
Owner(s) or Authorized Agent Printed Name: Ejsa
Owner(s) or Authorized Agent Signature: Date: 06/25(2O25
NOTE: If you are signing on behalf of the owner(s) a letter of authorization must accompany this application.
ii
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