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Land Use Permit Application Review Checklist.
Submission #:
Tax ID:
S -T -R:
Town:
What zoning district is the project located in?
❑R-1 ❑R-2 ❑R-3 ❑R-4 )--tR-RB El El El ❑A-1 ❑A-2 ❑F-1 ❑F-2 U ❑M -M
❑ Yes ti No
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:
❑ Yes t7` No
Is the project located in the Shorelands (Shorelands are lands within 300feet 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 tJNo
Are there wetlands on the property?
❑ Yes 1 J No
Is project associated with a nonconforming use or structure?
EI Yes ❑ No
Does the project require sanitary?
Sanitary Permit # Public System:
# of bedrooms:
❑ Yes 'M No
Does the project require an affidavit? ❑ LLC ❑ Trust
Affidavit #:
Number of Units:
Number of Bedrooms:
Number of Bathrooms: .,
Number of Stories:
❑ After -the -Fact (ATF)
ATF Fee Amount:
Inspected by: . a
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):
'U 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 C 6'r Suet
PO no, -iO3
\Vashbutn, tiff 54891
(715) 373-6109
ltcr ulit , r/ tf n tu: lEit�c�uutv�ti i.uiti
p TFJEJ 1)
�__
_Health
Zonin
Sul?nrission #
Fee Paid
—_.
Refund
Permit #
Date Issued
Shortzret Rent Aptilrc'atiort Packet
This application packet contains information Ibr a Shuri-4`crnt Rental permit through l3a, field ('ount)Y Planning and
Zoning Department, Completed application can be mailed/cmailcd to the address/email above.
SECTION A: ESTABIASIINHaNT INI+ORMATION
US(abl isl-mI It Nantc.
Cstablishntent 'Ia\ 11) Ir' `l ul /('iiv of
)C'D\ J ( Jj
kstablisltment Street Address iCtiv State Zip
I L15
SECTION B: OWNER INFORMATION
Property Owner - -. —
Lmail Address Phone Number
Uwa klaiiin — gym —
nc—
A lres�
5_J*C�k r�. [tate z�,�
CL
SECTION C: IF OPERATING WITH PARTNER OR AGENT
I cnal licensee ii�.ut�,�rship. I t t '. III', �n Im.) Entail Address
,' Phone Number
I. rcensec Street eet Address City State Zip JAgent Name (ii applicable) Phone Nurrthcr
LJ
_/
cilt Street Add css JCity State JiSECTIp
} D; RENTAL UNIT INFORMATION ryes Ncc r beIo )
unit 1 Unit ID titructurc IIca(in� 1c'ater ti nmtary Suurce ii of Stories 11 of h of
I vy ;tutee Source — —
— — _ Bedrooms Bathroo ± J
3
i ±1L Ti± t::± Hi
St met U me 'typc:
Ilouse (I-i) Dtlpjcx (U) Cabin ((') Yuri (1`) pannnent (A) C'oncio ('('O) rtther(c>�ilea�sc describe
e:rtut;; Snnrce; ----
Electric (I:) Nataral Gns (\U) I'rupne (P) Wooer (W) Fuel (1') Othi' (O), please describe
Water Son ice: — SanIl rrs Son tee: — —
Public/Municipal (rtAI) Private Well(I') 1Public:Illuni al (Ivi) Private )nsiie Waste to System (P)
0
Site Plan
Shoal location of:
11 Driveways ❑ Frontage Roads (include name) Cl L�isiing Structures ❑ Well (W) t l Septic Taal`.(Si) ( l Drain Field (Dl')
U I loldi Tank (I I l') (J Lake L 1 Rivar ❑ 5lre,lnl/C'.r�ck ❑ Pond ❑ Floodplain II Wetlands ❑ 51oP el;� C>vel 20°�
N ,
C ( 4 C'crUL
Sethncks t'rom Inrthesi extent includltit
raves and
j C'ouirty Use
Only
overhangs of structure to:
Verified setbacks
Road centerline
--
Ii,
11,
w_
Noles'Comtn�nts;
I ront Lot Line/Right-of-\\atv
Side I of Line I
olil Last South \Ve.,l. circle onet
It,
, yam{ _
Ii.
ail l lot Line 2 --a+-_-
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(North I &,i . oat)i \\ ltit. c11Clc one)
If1.
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Rear rLot Line
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1
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pHoldin-,
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Well
) ft.
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Existing Structure 'Building
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IL
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Welland
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Elevation of I-loodplain
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tt.
Ord nary I Iigh Water Mark (DI I WM)
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It
OTF;: Please intricate „xec attached'" on
this page II suhm
III lug site
bran .as t► separate doenUtenL
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]hayfield County Planning and Zoning Short -Term Renther1 it
PLANNING AND) ZONING QUESTIONS
I . Is the property ill the sliorcland, within 300 lcet of a river/stream OR landward side c.
of a lakelpond/tli,cvage. \liielievei is greater? C ;Yes i ] No U Unsure
I I ' a s ' No ❑ Unsure
_. Is there a wetland located on the pro �eri��'. ❑ 1 cti
.3. is there a iloodplain located on or near the property? ❑ Yes U No� Unsure_
'I. Is this project associated with any of the following: ❑ Rezone Li conditional I Ise
❑ Variance
5, Did v�ou contact the to'vn to see ifanr permitsheuirements apply to your' project?"E
plain
L .I Special Use
Yes ❑ No
Zoning Depart n►cnl fisu Permits: Slant-1,crrn Rental permits through l3aV field County Planning and Zoning Department
are non -transferable, except as per the exemptions identilicd in Al ('P 7?.tt�l(3), Short-] crnr Rental permits are regulated
by Hayfield ('ount)Ordinance Section 13-I-35.
APPLICATION FEES ($500 per unit)
Check or money order payable to 13ayfiield County Planning and Zoning
I unit : ,`17500 2 units : 51.000 t traits $1.501) I units : S?.000
In ensure Your application is complete and call he processed by the Department. check on have the It�llowing items:
[Applicant liifi rtnation (Paige I)
C Site Plan (i'a .te 2)
loon Plan(s) - Provide sheet fir each floor ithin each (alit.
I (eve) declare that this application. inclirdiug any accompanying iiilormation, has been esantiued by me (us) and to the
hest of illy (our) knowledge and belief it is true, correct, and complete. I (wc) ackno'.'. ledge that I (we) aut (are)
responsible I'or the detail and accuracy n1'all inforntation that I (we) are proviilittg and that will be retied upon by Uaylield
County in determining vhethcr to issue a pcnnit, I (we) Further accept liability which inav be a result ol` C3ayhcld Connt�
relying on this inlorniation I ('rc) are providing in or with this application. I (wc) consent to county officials charged with
adminiwlcring, county i:n'dinances to have access to the abovedescribed property ;it any reasonable limee liar the purpose of
inspection,
j/
{)wlier(s) or Authorized Agent Printed Name:
j
I)'.'. net(s) or ,Aillhori/.cd Agent Signature: tc 't ) ' Date: _ ___
NO E: If you are signing on behalf of the owner(s) a letter oi':tu(hori,atiun must acconii►ai►y this application.
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