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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 CiT ❑C ❑I ❑M ❑A-1 ❑A-2 ❑F-1 ❑F-2 ❑W ❑M -M
❑ Yes `❑°No
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:
❑ Yes L'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 'L No
Is the project located in the Floodplain?
Zone:
❑ Yes LrNo
Are there wetlands on the property?
❑ Yes ,CiT No
Is project associated with a nonconforming use or structure?
1Yes ❑ No
Does the project require sanitary?
Sanitary Permit #: . LL Public System:
# of bedrooms:
❑ Yes No
Does the project require an affidavit? ❑ LLC ❑ Trust
Affidavit #:
Numberof Units:
Number of Bedrooms:
Numberof 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):
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.
ii 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`h Street
PO Box 403
Washburn, WI 54891
(715) 373-6109
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1R--°-YFIELD
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a� p
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 l
Establishment Tax ID #
Town/City of
Establishment Street Address
0
City
State
X
Zip
51
SECTION B: OWNER INFORMATION
Pro erty Owne
74'1
Email Address
Phone Number
Owner Mailing Address
'UA.1T 7 W4I7
City
State
4/
Zip
557- 7
7
SECTION C: IF OPERATING WITI4 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
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
I
C
E
P
I
2
3
4
Structure Type:
House (H) Duplex (D) Cabin (C) Yurt (Y) Apartment (A) Condo CO Other (0), please describe
Heating Source:
Electric (E) Natural Gas G Propane (P) Wood (W) Fuel (F) Other (0), please describe
Water Source:
Public/Municipal (M) Private Well (P)
Sanitary Source:
Public/Municipal M Private Onsite Wastewater System (P)
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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 floo 1plain 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:
LJ Applicant Information (Page 1)
' Site Plan (Page 2)
10 Floor Plan(s) — Provide sheet for each floor within each unit,
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) or Authorized Agent Printed Name' 5 ,41i1
Owner(s) or Authorized Agent Signature: aa_1tL9_ __ Date:
NOTE: If you are signing on behalf of the ow- , I'ef uth¢rf�Lion must accompany this application.
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