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Land Use Permit Application Review Checklist
Submission #:
Tax ID:
S -T -R: R:
Town:
What zoning district is the project located in?
❑R-1 ❑R-2 Li R-3 ❑R-4.ER-RB Li ❑I ❑M ❑A-1 ❑A-2 ❑F-1 Li F-2 ❑W ❑M -M
❑ Yes 1 No
Does lot meet the zoning dimensional requirements or is it substandard?
-.
Deed of record:
❑ Yes LI 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 J No
Are there wetlands on the property?
❑ Yes Li No
Is project associated with a nonconforming use or structure?
[Yes ❑ No
Does the project require sanitary?
Sanitary Permit #: Public System:
# of bedrooms:
1 Yes `'Callo
Does the project require an affidavit? ❑ LLC TLt rust
Affidavit #:
Number of Units:
Number of Bedrooms:
Number ofBathrooms: ,
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:
Condition(s):
Li 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.
'Q 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:
\\'ao;hlnu n. AV' 'I
(715)373-6109
lx;l'itrli��flit.r !t+'l�t�_t��11Y11'e\VI, 14±eti
s=. M/ . I U
I lealtlt upon Y
;ubnris iprt( _
hee Paid
ttcfund
Permu #�
ID;tte Issued
}
Shut t Tit m Rental Application Packet
I his application pocket contains infornmtiun I'ur a Shod -Tenn Rental permit thnrugh Baylield (oust)^ Planning and
toning, Department, Completed application can he mailed/entailed to the adch-es,/eutail above.
SECTION ESTABLISHMENT INFORMATION — —
Establishment Name Establishment Tax II) 9 Tnvvn/Cit\ of
Ah1 �1ev1v�: >t'( f U I Ably.
istab! ishmrnt Street Address Stale F,/s"�
C'il}`
SECTION I3: O' VNNER INFORMATIOCd
> —— _ h,mut) Address , )�
Phone Nniitbcr
� sit cr 19$� ,�z�,C�r.� _�7�� - _—
)ncr Mailing Address ' Ci State Zip
SECTION C: IC OPERATING WITH_PARTNER OR AGENT legal Licensee ti utncrr;hil, tic. ii P, tic ) Email Address Phone Nunthcr
licensee Street Address
(:ily Slate l,ip
Agent Name (it "applicable) l rnatl Addr n a�nU Cdwl
ii i'Itone Number
l� tSJ11— �i $ �%Ct iL 1C % —L Agent Street Addre s City Stale tip
SECTION_1): RENTAL IT INFORMATION ice
1)nit Unit It) " Structrne I leatine Water
t-sJ t}I7e tii�rn+'c ,uurrc
Ap'
I, ► •.L.
SunitarSource
s
1; at StorieBedrounis
of
Structure type:
I lob e (II i Duplex (D) C'abii7 ((') Ynrt (Y) Apartment (A) (`ondu (('(?) (Mier (t )), ,lease de^�>crihe ---
Ilent ing Source:
Hectric (C) Nan -al (ias (NG) Ptg pane (P) \V'ood t \\ ) fuel ( f ) Other (O),_pleuse dcscrihe
Water Source: Sanitary source:
I'uhlic'i\1- -iI iurl (M) I'ri�,rte Well (I') Public?Murucrt,ul (MI siern (I')
•
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(Mayfield County planning and Zoning Short -Term Rental Permit
PLANNING, ANI) l.+DiV�NU QUESTIONS
I, Is the pt'c>pc.ltl' in the shaleiand, w Rhin 300 iaet of rivet/stream OR lanelcutd 4de of Ilnod1'drlin OR 1000 feet
ul'tt lakclpnnd/llo\\ age. whichever is greater? M"Yes U No U Unsure.
2. Is there a wetland located on the prnperty7 [J Yes Nn U I Insure
3. Is there a floodplain located on or near the property,? U Yes U No t Unsure
4. Is this project associated with any of the following: ❑ Rezone n Conditional Use Li Special I ls;e
I _J Variance
5. I)id )ou contact the town to see it anypermits/requirements apply to gout' project?esL1No
Zoning Department Use Permits: Shiirt ferny Rental permits tlu'nugh flu Field County Planning and Zoning Department
are Icon transleurtthlc. except as per the exemptions idetttibed in A'I'CP 72,0 (3). Short -Term Rental permits are regulated
by 13H)1lcId (-'aunty Ordinance Section I:i-I-+w,
APPLICATION FEES (5500 per unit)
Check or money order payable to [3ayfield County Plaint ing and Zoning
I unit : $500 1 2 units : $1,00(1 1 3 units :$ $1.50(1 1 4 units : 'i 2MOt)
to ensure your application is complete raid can he processed by Ilie l)epartntcnt, cheek you have the following items:
I Applicant Information (Pae.e I)
Li Site Plan (Page 2)
Li Floor Plait(s) — Provide sheet ha- each flour within each unit.
I (cce) declurc that (Iris application. including ally accotnpall) ing inlorniation, has been examined by me (u ") r'jlitl to (he
best uI ni (our) hnocv ledge and helief it is true, correct. and complete. I (cvc) acknotledge that I (we) ant (are)
responsible h.>r the detail and accuracy of ll ink rmatinn that I (we) are plrwiding and that "ill he relied upon h), Uayheld
County in determining vnether to issue a permit. I (cue) further accept liability hicll nm he a result of flu held County
relying, tat this infortnaliall I (we) lure providing in or vyith this' application. I (eve) Consent to ct>unty ol'licials ehargcd o. ith
adnlinistcriltg, count) ordinances to have access to the ahoy c -described properi) at an), rcttsonublc time for the purpose of
inspection. l
Ocrner(s) or Authori7ed Agent Printed ('statue:
I, )"ner(: )
or Authori,etl Agent Signature: C
, ;
Date:
NO) f'E: H
)rot are signing on lwhali ol'the
to ne r(s)
a lktter of alit lorization
mast tiCCOmpanl'
this application.
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