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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"DR-RB ❑C ❑I ❑M ❑A-1 ❑A-2 ❑F-1 ❑F-2 ❑W ❑M -M
❑ Yes 0No
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:
LllYes ❑ 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 I No
Are there wetlands on the property?
LI Yes ❑ No
Is project associated with a nonconforming use or structure?
{Li Yes ❑ No
Does the project require sanitary?
Sanitary Permit #: Public System:
# of bedrooms:
L`Yes ❑ No
Does the project require an affidavit? ❑ LLC l'Trust
Affidavit #:
Number of Units: t
Number of Bedrooms:....₹
Number of Bathrooms: I`
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):
`LJ 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.
p -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 la 6°i Street
- µ)) Health YFIELD Health Zon➢n
j() Box 403 Submission # ,
Washburn, WI 54891 ay Fee Paid
(715)373-6109 Refund
,rn1it;, %I)aal1hmit]ty.)t )V Permit#
Date Issued
Short -Tern, Rental Application Packet
This application packet contains information for a Short -Terns 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
ihirY1Lh � 1 aYA s
Establishment Tai II) # ow/City of
lJkoYe
lC.i!C�r,toi)
Establishment Street Address
4' X a- ( 6 Aq gal
City
� 1
State
L,(1
Zip
SECTION B: INFORMATION
OWNER
Property ��Owner � Email Address � � Phone Number
' cc ? I u t,vv _7/5
7q_y-- zs I
Owner Mauling Address F City
�U� C 1,c
State
W
Zip
_9,2-1
SECTION C: IF OPERATING WITH PARTNER OR AGENT
Legal Licensee (partnership. LL(, I.t.P or Inc.) I Email Address
Phone Number
f
Licensee Street Address City
1 State
Zip
/
Agent Name (if applicable) Email Address
Phone Number
Agent Street Address City
— _
State
Zip
SECTION
D: RENTAL UNIT INFORMATION (see key
below
Unit
Unit 11)
Structure
Heating
Water
Sanitary Source
tt of Stories
t! of
N of
Type
Source
Source
13edroorns
Bathrooms
1
3
Structure Type:
l lou
) Duplex (D) Cabin (C) ti'urt (Y) Apartment A) Condo (CC)) Other (U), please deset•ibc
ng rce:
Electric (E) Natural Gas (NG) Propane (P) Wood (W) Fuel ('F) Other (O), please
describe
Water Source: J Sanitary Source:
Public/Municipal (tM) Private Well (P) I Public/Municipal (M) Private Onsite Wastewater Svstent (P)
p�p
Site Plan
Show location of:
❑ Driveways ❑ Frontage Roads (include name) ❑ Rxisting Structures ❑ Well (W) ❑ Septic Tank (ST) ❑ Drain Field (DF)
❑ Holding Tank (I IT) ❑ Lake ❑ River ❑.i Stream/Creek ❑ Pond ❑ Floodplain El Wetlands 1=1 Slopers over 20%
Setbacks from furthest extent including
eaves and
County Use
Only
overhangs of structure to:
Verified setbacks
Road Centerline
Ii,
ft.
Notes/Comments:
Front Lot Line.Right-of-Wav
ft.
ft.
Side Lot Line I
ft.
Ii.
(North Gast South West. circle one)
Side Lot Line 2
ft. 1
ft.
(North I ast South West. circle one)
'
ft.
Rear Lot Line
ft.
Septic "Holding "Tank
Ii.
ft.
DrainIield
It.
ft.
Privy
ft.
ft.
Well
It.
ii.
GXiSting SU'uCtm'e/L3uilding
It.
ft.
Wetland
ft.
ft.
LIevation of Floodplain
it,
ft.
Ordinary IIigh-Water Mark (O11WM)
Ii.
ft.
NO'T'E: Please indicate "see attached" on this page il'submitting site plan as a separat
2
Bayfield County Planning and Zoning Short -Term Rental Permit
PLANNING AND ZONING QUESTIONS
I Is ofirre property in lakc/pon I/flow 1 e� ��Iti e thc�e►tistn �ce�ter0 �ct river/stream c�la Yes❑N❑ OUnsure
landward side ol't7oodplain OR 1000 fleet
I sure
2. Is there a wetland located on the property? ❑ Yes 'No ❑ Unsure
3. Is there a Hood plain located on or near the property? ❑ Yes No ❑ Unsure
4. Is this project associated with any of the following: ❑ Rezone ❑ Conditional Use Li Special Use
L I Variance
5. Did you contact the town to see if any peunits/reyuiremcnt fly to your project'? ❑ Yes ❑ No
Zoning Department Ilse Permits: Short -'fern Rental permits through Hayfield County Planning and Zoning Department
are non -transferable, except as per the exemptions identified in ATOP 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 13 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:
Ii Applicant Information (Page I )
Li Site Plan (Page 2)
Li 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 Hayfield
County in determining whether to issue a permit. I (we) further accept liability which may be a result of Hayfield County
relying on this information I (rye) 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. / 1
Owner(s) or Authorized Agent Printed Name:
Owner(s) or Authorized Agent Signature:
Date: > r.
NO'l'l': If You are signing on behalf of the owner(s) a letter of authorization must accompany this application.
3
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