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SC
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 `j R-3 ❑R-4 ❑R-RB ❑C ❑I ❑M ❑A-1 ❑A-2 ❑F-1 ❑F-2 ❑W ❑M -M
Eli Yes ❑ No
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:
El 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 JT1No
Are there wetlands on the property?
❑ Yes j]'No
Is project associated with a nonconforming use or structure?
LIYes ❑ No
Does the project require sanitary?
Sanitary Permit #: �,�: Public System:
# of bedrooms: -
❑ Yes 'O 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:
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):
LfTown/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.
'C I 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 6111 Street
PO Box 403
Washburn, WI 54891
(715) 373-6109
pimit@)hylieIIoun1Wi, «y
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
HQc,VNYqc�,lc
Establishment Tax ID #
w D
Town/City olf
9v )4
Establishment Street Address
5/6C avrn c r( AO
City
rd l_
State
L�fi
ip
5 g 1
SECTION B: OWNER INFORMATION
Property Owner
v c� o
Email Address GP
o�� t r
hone Number
3 l� 3 SID
Owner Mailing Address -
City
State
Zip
SECTION C: II 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 a plicable)
m r ,J, LLC
Email Address J
Ch e 1 1 rreL
Phone Number
71s- 77o7
07
Agent Street Address
?3G9 90 ak"'cL1 Rd
City
C l e
State
' 'i
Zip
5-?,)
SECTION D: RENTAL UNIT INFORMATION (see ke
below)
Unit
Unit ID
Structure
Type
Heating
Source
Water
Source
Sanitary Source
# of Stories
# of
Bedrooms
# of
Bathrooms
3l
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 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 9 Frontage Roads (include name) ®' Existing
Structures N" Well ( ) St c Tank (ST) l<Drain Field (DF)
LI Holding Tank (HT) Lake ❑ River ❑ Stream/Creek
❑ Pond ❑ Floodplain b Wetlands ❑ Slopers over 20%
N
Setbacks from furthest extent including eaves and
County Use Only
overhangs of structure to:
Verified setbacks
Road Centerline
' ft.
ft.
Notes/Continents:
Front Lot Line/Right-of-Way
— ft.
ft.
Side Lot Line 1
ft.
ft.
(North East South est circle one)
�
Side Lot e 2
.� ft.
ft.
North ast outh West, circle one
Rear Lot Line
9 5 ft.
ft.
Septic/Holding Tank
ft.
ft.
Drainfield
ft.
ft.
Privy
.—' ft.
ft.
Well
ft.
ft.
Existing Structure/Building
ft.
ft.
Wetland
C j ft.
ft.
Elevation of Floodplain
ft.
ft.
Ordinary High -Water Mark (OHWM)
® ft.
ft.
NOTL: Please indicate "see attached" on this page if submitting site plan as a separate document.
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 ❑ 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? 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 ($500 per unit)
Check or money order payable to Bayfield County Planning and Zoning
1 unit : $500 2 units : $1,000 3 units : $1,500 4 units : $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. Bj / U? Paw p/'t
-
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) A or Authorized Agent Printed Name: � C��� �
Owner(s) or Authorized Agent Signature:
Date:
NOTE: If you are signing on behalf of the o«'ner(s) a letter of authorization must accompany this application.
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