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Land Use Permit Application Review Checklist
Submission #:
Tax ID:
S -T -R h. to
Town:
What zoning district is the project located in?
❑R-1 El R-2 ❑R-3 [I R-4 LI°R-RB ❑C ❑I ❑M ❑A-1 El A-2 ❑F-1 ❑F-2 ❑W ❑M -M
❑ Yes `'LI No
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:
❑ 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 CI'No
Is the project located in the Floodplain?
Zone:
❑ Yes l No
Are there wetlands on the property?
❑ Yes 'p No
Is project associated with a nonconforming use or structure?
L Yes ❑ No
Does the project require sanitary?
Sanitary Permit #: Public System:
# of bedrooms: .� ..
❑ Yes ',No
Does the project require an affidavit? ❑ LLC El 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: , f
Condition(s):
FTown/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.
jsl 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:
1I 7 E 6street y1�IELD
PO Box 403 -1
Washburn, WI 54891
(715) 373-6109
17�UOiIs a h'i_ylichla O LBMry VJA. 0y1
Health Zonin
Submission #
Fee Paid
Refund
Permit #
Date Issued
Short -Term Rental Application Packet
This application packet contains information for a Short -Term Rental permit through Bayf►eld County Planning and
Zoning Department. Completed application can be mailed/emailed to the address/email above.
SECTION A: ESTABLISHMENT INFORMATION
Establishment Name, Establishment Tax ID #
Establishment Street Address City
�B:00W�NE�RW(6,R�MATION
�( I� ?
SECTION
Property Chvner Email Address
Owner Mailing Address i City
SECTION C: IF OPERATING WITH PARTNER OR AGENT
Legal Licensee (partnership, LL(', I,Li', or !nc limnil Address
Licensee Street Address
Agent Name (ifi applicable
Agent Street Address
Email Address
SECTION D: RENTAL UNIT INFORMATION (see
Unit
Unit ID
Structure
Ileafing
Water
Source
Source
2
4
Shucture Type:
House (11) Duplex (D) Cabin (C) Yurt (Y) Apartmet
Heating Source:
Ci
/City of
State ip
r
Phone Number
3 (-7 53 - 35
State Zip
Phone Number
C5 -q/ - -_
State Z.i j
r
_Phone Number
City State L7.ip
below — .
Sanitary Source [ioieJ hi of a of
Bedrooms Jjathrooms
u'lechric (E) Natural Gas (NU) Pa ne (P) Wood ( W) Fuelft
Water Source: Sanitary Source:
Public/Munic al (M) _Private Well (P) I Public/Municipal (M)
Condo (CO) Other (O),-ple;
Other {O),1Dlease describe
describe
Site Plan
Show location of:
El Driveways El Frontage Roads (include name) ❑ Existing Structures U Well (W) El Septic Tank (ST) ❑ Drain Field (DF)
❑ I biding Tank (}1T) El Lake ❑ River ❑ Stream/Creek ❑ Pond 11 Flood lain ❑ Wetlands El Slo tpees over 20" 0
Setbacks from furthest extent including eaves and County Use Only
overhangs of structure to: Verified setbacks
Road Centerline ft. 1 . Notes/Comments:
Front Lot Line 'Right -of -Way ft, ft.
Side Lot Line I ft. ft.
(North East South West, circle one)
Side I.ot Line 2 Ii. ft.
(North Last South West circle one)
Rear I.ot Line ft. 11.
Septic/llolding Tank ft, 1t.
Draintield 1ft', ft.
Privy 1t.ft.{
Well
LXisth1g Structure Ruildmg
Wetland — _ ft. ft.
Elevation of Floodplam tt. ft.
Ordinal)Iligh-Water Mark (OI-IWM) J ft. tt.
NOTE: Please indicate "see attached" on this page if submitting site plan as a separate document.
2
Bayfield County Planning and Zoning Short -Term Rental Permit
PLANNING AND ZONING QUESTIONS
Is the property in the shoreland, within 300 feet of a riverlstreanl Ok landward side of Iloodplain OR 1000 feet
of a lake/pond/flowage, whichever is greater? ❑ Yes $ No ❑ Unsure
2. Is there a wetland located on the
3
4
❑ Yes l,No ❑ Unsure
Is there a foodplain located on or near tit ropert3"? ❑ Yes .KNo O Unsure
Is this project associated with any of the following: ❑ Rezone ❑ Conditional Use
❑ Variance
_ Did you contact the town to see if an
❑ Special use
eats ap ply to your project'? ❑ Yes O No
Zoning Department Use Permits: Short -'Term Rental permits through Baylield County Planning and Zoning Department
are non transferable, except as per the exemptions identified in ATCP 72.04(3). Short-T'erm Rental permits are regulated
by f3aytieid 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 I3 units : $1,500 I 1 units : $2,000
'l'o ensure your application is complete and can be processed by the Department, check you have the following items:
❑ Applicant Illf0rmation (Page I )
❑ Site Plan (Page 2)
Ci 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 title, 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
I'elyillg oil this informal ion I (we) are providing ill or \\ iii tilis application. 1 (we) Consent to county officials charged with1
administering county ordinances to have access to t above -described property at any reasonable time for the purpose of inspection,
Owner(s) or Authorized Agent Printed Name:a Z'
Owner(s) or Authorized Agent Signature:,
Date:
NOTE.: If you are sign lug on behalf of the owner(s) a letter of authorization must accompany this application.
3
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