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-FIELD 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:
UNDINE, THOMAS R
78780 STATE HWY 13
WASHBURN, WI 54891
Description
1 unit
Submission Number:
STR-00318
Transaction Number:
STR-00318-37AEB
Amount
$500.00
Total: $500.00
Payment Amount: $500.00
Reference: 1144
Paid by: Thomas Undine
Payment Type: Check
Transaction Date: 10/31/2025
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
Land Use Permit Application Review Checklist
Submission #: OO31 Tax ID: (p 5`-]
S -T -R: Town:
What zoning district is the project located in?
❑ R-1 El R-2 El R-3 El R-4 R-RB ❑ C ❑ I El M ❑ A-1 ❑ A-2 ❑ F-1 ❑ F-2 ❑ W ❑ M -M
❑ Yes No Does lot meet the zonidmens.QnaJ_.r_equirements or is it substandard?
Deed of record:
❑ Yes `p 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:
❑ Yes 2No Are there wetlands on the property?
El Yes o Is project associated with a nonconforming use or structure?
(Yes ❑ No Does the project require sanitary?
Sanitary Permit #: 08-1S1 S Public System:
# of bedrooms: 2oo11
❑ Yes XNo Does the project require an affidavit? ❑ LLC ❑ Trust
Affidavit #:
Number of Units: 1
Number of Bedrooms:
Number of Bathrooms:
Number of Stories: 2
❑ After -the -Fact (ATF)
ATF Fee Amount:
Inspected by: Date of Inspection:
Inspection Notes:
Re -Inspected by: Date of Re -Inspection:
Denied by:
Date of Denial:
Reason for Denial:
Date Denial Letter Mailed:
Approved by: Date of Approval: o -3\-
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.
'lgShort-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:
117E 6th Street
PO Box 403
Washburn, WI 54891
(715) 373-6109
ermits(a,bayfieldcounty.w
YFIELD
Health
Zoning
Submission #
rl.-0a 15
Fee Paid
Refund
Permit #
Date Issued
Short -Term Rental Application 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. Establishment Tax ID can be found
through NOVUS(https://novus.bayfieldcounty.wi.gov/access/master. asp)
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 pages 1-5.
SECTION A: ESTABLISHMENT INFORMATION
Establishment Name
Ejishmgnt Tax, ID # Town/City of
: ____
City ` State Zip
� f G'1 ►tam 5 ci
Estaliflishment Street Address
V
SECTION B: OWNER INFORM ION
Property Owner
Email Address
C1 ,
Phone Number
� 3 :- - 7o0Owner
Mailing Ad ress
r 796 U
City
V`�2kV\ jt
State
Zip
≤)
SECTION C: IF OPERATING W11'H 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 key
below)
Unit
Unit ID
Structure
Type
Heating
Source
Water
Source
Sanitary Source
# of Stories
# of
Bedrooms
# of
Bathrooms
'2
•1,
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 (NG) Propane (P) Wood (W) Fuel (F) Other (O), please describe
Water Source:
Public/Municipal (M) Private Well (P)
Sanitary Source:
Public/Municipal (M)Private Onsite Wastewater System (P)
Site Plan
Show location of:
❑ Driveways O Frontage Roads (include name) ❑ Existing Structures ❑ Well (W) ❑ Septic Tank (ST) ❑ Drain Field (DF)
❑ Holding Tank (HT) ❑ Lake ❑ River ❑
Stream/Creek 0 Pond 0 Floodplain ❑ Wetlands ❑ Slopers over 20%
N
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t
rVvwe
f
e r'3
q,
C1
4
tt'
- V",-) 4b3 :4e3htid 4:f -
Setbacks from furthest extent including
eaves and
County Use Only
overhangs of structure to:
Verified setbacks
Road Centerline
A b ft.
ft.
Notes/Comments;
Front Lot Line/Right-of-Way
j Oft.
ft.
Side Lot Line 1
ft.
�jC)
ft.
(North East South West, circle one)
Side Lot Line 2
j ft.
¼)
ft.
(North East South West, circle one)
Rear Lot Line
/O) b ft.
ft,
Septic/Holding Tank
ft,
ft.
Drainfield
ft.
ft.
Privy
ft.
ft.
Well
j O ft.
ft.
Existing Structure/Building
ft.
ft.
Wetland
ft.
ft.
Elevation of Floodplain
ft.
ft.
Ordinary High -Water Mark (OHWM)
ft.
ft.
NOTE: Please 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 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 Piercing Establishments outlines the licei�stih` 5'r�l jra r`i" th d`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 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.
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 Year -Round
❑ $586.30 — License Fee ($286.30 (County fee: $272, State fee: $14.30)) + 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 A in rative code(s). Personally identifiable information you provide may be
used for ppDsther than that or w i it wa collected (Wis. Stat. § 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? ❑ Yes 1 'No ❑ Unsure
2.
Is there a wetland located on the property? ❑ Yes No ❑ Unsure
3.
Is there a floodplain located on or near the property? ❑ Yes ' No ❑ Unsure
4.
Is this project associated with any of the following: ❑ Rezone ❑ Conditional Use ❑ 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
by Bayfield County Ordinance Section 13-1-35.
APPLICATION FEES
Check or money order payable to Bayfield County Planning and Zoning
1 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:
❑ Applicant Information (Page 1)
❑ Site Plan (Page 2)
❑ Floor Plan(s) — Provide sheet for each floor within each unit.
❑ 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:
Owner(s) or Authorized Agent Signature:
Date: L a' ?
NOTE: If you are signing on behalf of the owner(s) a letter of authorization must accompany this application.
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