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Land Use Permit Application Review Checklist
Submission #: -rid- Oba^1
Tax ID: 8 Z0'2.
S -T -R: 3W,-51—o(a
Town: 3et!
What zoning district is the project located in?
❑R-1 ❑R-2 ❑R-3 R-4 ❑R-RB ❑C ❑I ❑M ❑A-1 ❑A-2 ❑F-1 ❑F-2 ❑W ❑M -M
❑ Yes No
Does lot meet the zonin ' .ensional re uirements 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 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?
❑ Yes No
Is project associated with a nonconforming use or structure?
❑ Yes No
Does the project require sanitary?
SanitaryPermit #: Public System: j3e
# of bedrooms:
❑ Yes No
Does the project require an affidavit? ❑ LLC ❑ Trust
Affidavit #:
Number of Units: 1
Numberof Bedrooms:
Number of Bathrooms:
Number of Stories:
❑ 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:
�c
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 of ____ persons.
❑ 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, WI 54891
(715)373-6109
(4;
p' `YIELD
permits bavficldccru tv.tivi. ov
Health '
Zoning
Submission #
Fee Paid
Refund
Permit #
Date Issued
Short -Term Rental Application Packet
This application packet contains information for a Short -Team 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
Establishment Tax ID #
Town/f
Establishment Street Address
227I65k re
City
Cornicop
State
w;
Zip
521
SECTION B: OWNER INFORMATION
Property Owner
'VCoy
Email Address I
Phone Number
Owner Mailing Address
P6a?C. a31
City
t l� ;
State
; LILI
Zip
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
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 (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)