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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?
f. R-1 ❑ R-2 ❑ R-3 ❑ R-4 ❑ R-RB ❑ C ❑ 1 ❑ 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:
Li 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 Li No
Is the project located in the Floodplain?
Zone:
❑ Yes `S' No
Are there wetlands on the property?
'LI.Yes ❑ No
Is project associated with a nonconforming use or structure? =t
Yes ❑ No
Does the project require sanitary?
Sanitary Permit # Public System:
# of bedrooms:
❑ Yes Li No
Does the project require an affidavit? ❑ LLC ❑ Trust
Affidavit #:
Number of Units: 2).
Number of Bedrooms:
Number of Bathrooms:
Number of Stories A
❑ 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):
$Town/State/DNR/Federal
'Li 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.
1.,1 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 6ih Street
Po Box 403 P YFIELv
Washburn, WI 51891
(u7lyy) r(373ca,�(�9
1 �. vi«„�
Health
Zoning_
Submission #
Fee Paid
Refund
Permit #
Date Issued
Short -Term Rental Application Packet
This application packet contains information fora 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 ► Establishment Tax 1D #
Establishment Street Address City
t,
T.07 AE�t1t ( __ Ic
SECTION B:OWNER lfN ORMATION
Properly. Owner I Email Address
• C
`V►11J ,r, ► G ( l .IZ' rii ud JV('10 r14
Owner Mailing Address I City
SECTION C: IF OPERATING WITH PARTNER OR AGENT
Legal Licensee (hnrtncrship, ►,I,C, u.R, or Inc.) Email Address
.o1iL piJ c
Licensee Street Address J City
_
Agent Name ►f applicable
C (• applicable) I ) � Email Address
Agent Street Address C►t
SECTION
D: RENTAL
UNIT INFORMATION see I
Unit
Unit 1D
Shvcture
Beating
Water
T �eJ
Source
Source
ity of
State I Zip
Phone Number
State Zip
I Phone Number
tLL z
State Zip
Phone Number
State I Lip
Sanitary Source # of Storiesj of JU of
—__L Bedrooms j Bathrooms
_�' 2_ z
Structure Tylae: —
Ilouse (11) Dui lex (D) Cabin (C) Yurt (Y) _ Apartment (A) Condo C'O) Other (C)) jeasc describe
Heating Source:
Electric (I') Natural Gas (NO) Pro?ane (I') Wood (W) Fue1 (F) Other (O), please describe
Wit' Source:
Sanitary Source:
Public a)(M,) Private Well P Publ►c'Munic►pal (M) Private Onsite Wastewater System (P)
Site Plan
NOTE: Please indicate "see attached" on this page it submitting site pian as a separate uoctnuent.
Bayfield County Planni
and Zoning Short -Term Rental Permit
PLANNING AND ZONING QUESTIONS
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/Ilow age, whichever is greater? , Yes ❑ No [1 Unsure
f
Is there a wetland located on the
❑ Yes No ❑ Unsure
Is there a fluodplain located on or near the l perty'? ❑ Yes No ❑ unsure
Is this project associated with any of the following: ❑ Rezone ❑ Conditional Use ❑ Special I Use
l Variance
5. Did
U contact the town to see if a
its/re�c uirements apply to your project? ❑ Yes El No
Zoning Department Use I'erinits: 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
I unit : $500 2 units: $1,000 3 units: $1,500 4 units: $2,000
To ensure your application is complete and call be processed by the Department, check you have the following items:
Li Applicant Information (Page I)
❑ Site Plan (Page 2)
❑ Floor Plan(s) - Provide sheet hbr 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 (ewe) 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: 4 " -
Owners) or Authorized Agent Signature: y Date:
NOTE: If you are sigi ing on behalf of the owner(s) a letter of authorization must accompany this application
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