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Land Use Permit Application Review Checklist
Submission #: :
Tax ID:
S T R:r
What zoning district is the project located in?
❑ R-1 ❑ R-2 ❑ R-3 ❑ R-4 `J,R-RB ❑ C ❑ I ❑ M ❑ A-1 ❑ A-2 ❑ F-1 ❑ F-2 ❑ W ❑ M -M
❑ Yes ,N0
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:
U 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:
❑ Yes [No
Are there wetlands on the property?
p Yes ❑ No
Is project associated with a nonconforming use or structure?,w
❑ Yes ❑ No
Does the project require sanitary?
Sanitary Permit #: Public System:
# of bedrooms:
❑ Yes ;No
Does the project require an affidavit?
Affidavit #:
Number of Units: N.
Number of Bedrooms: 2 v
Number of Bathrooms: I i
Number of Stories:
❑ After -the -Fact (ATF)
ATF Fee Amount:
Inspected by:
Date of Inspection:
Inspection Notes:
$ E1
pp
Re -Inspected by:
Date of Re -Inspection:
Denied by:
Date of Denial:
Reason for Denial:
Date Denial Letter Mailed:
Approved by: ,
Date of Approval:
_1s
S� , wens
I
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.
Y Short -Term Rental is for a maximum occupancy of persons. ,l
El Additional conditions may be placed and need to be adhered to at the time of permit issuance
Other Conditions:
117 E 6"Street
PO Box 403
Washburn, W154891
(715) 373-6109
l erne s byfieldcounty.wi gov
Health
Zoning
Submission #
Fee Paid
Refund
Permit #
Date Issued
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
HS 1 ECREAtL'PR0P& TICS TNC
Establishment Tax ID #
Town/City of
Establislunent Street Address
25200 S. GiAfziwN Avt
City
Ci4PvLG
State
_1
Zip
1S $26
SECTION B: OWNER INFORMATION
Property Owner
NE R°( tCitUTT
Email Address
Phone Number
Owner Mailing Address
25200 S, ChWmN A\ E
City
Cfi&E
State
v.I
Zip
5y 821
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 key
below)'
Unit
Unit ID
Structure
Type
Heating
Source
Water
Source
Sanitary Source
# of Stories
# of
Bedrooms
# of
Bathrooms
1
p
p
Z
Z
''i
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)