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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 QR-RB ❑C ❑I ❑M ❑A-1 ❑A-2 ❑F-1 ❑F-2 ❑W ❑M -M
❑ Yes "l'No
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:
❑ Yes C7:,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 fl No
Are there wetlands on the property?
❑ Yes 'U No
Is project associated with a nonconforming use or structure?
L1'Yes ❑ No
Does the project require sanitary?
Sanitary Permit #..� Public System:
# of bedrooms:
❑ Yes 'CI No
Does the project require an affidavit? ❑ LLC ❑ Trust
Affidavit #:
Numberof Units:
Numberof 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):
❑..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.
t -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'"' Street
PO Box -103
Washburn, W1 54891
(715) 373-6109
CI II] a t ylicldcotutt}-wi.g v
iii Health Zoning
Submission #
Fee Paid
Refund
Permit #
Date Issued
Short -Terns Rental Application Packet
'ibis application packet contains inlotmation for a Short-Tenii Rental permit through Bayfield County Planning and
Zoning Department. Completed application can be trailed/emailed to the address/email above.
SECTION A: ESTABLISHMENT INFORMATION
Establishment Name Establishttlent. Tax ID # oyrt Ct ` �-•t) of
�GY V1S �(JC1 `LODDGS /!/t ��
Establishment Street Address C -
Lt _ )' State
L�� a. vet k, i (-c dvA Ca 19I rr
SECTION B :OWNER INFORMATION
4
Property honer Email Address �� Phone Number
rb
`'
Owner Matltrg Address City
cm A0 Gk
SECTION C: IF OPERATING WITH PARTNER OR AGENT
Le gal Licensee (partnu,hyp. I (.', Ill, or lnc,1 Email Address
— — )r ' I SCI t voi✓ ' < I'C c of .
Licensee Street Address
ter} �}',� j/j City
}
Agent Name (if applicable) — —
�L;mail Address
Agent Street Address
City
State
Phone Number
State
(,C)l
Phone Number
State
6(71
Zip
-cis
Zip
/002
SECTION D: RENTAL UNIT INFORMATION (see Ice below)
Unit Unit ID structure 1lcating Water Sanitary Source # ofstories of 4, of
,I ca SoUree Source _ _ Bedrooms Bathrooms
3
4
Structure Type:
House (111) Du )lex (D) Cab ( ) ( gttment (A) Condo (CO) Other (O), ylease describe
Cabin C Yurt Y A a„_._—_
Healing Source: — —
1 lectric (E)_Nalural (gas (NG) Pro )are (l') Wood (W) Fuel (F) Other (()), �leasc deseribe
__
Water Source:
Sanitary Source:
Public/Munal (M) Private Well (P) I'ubliC1V1Ut1ie1 )al (M) PI•iVat� Onsite Waste�cater System (P)
�,
61