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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 El R-4 DR-RB ❑C ❑I El ❑A-1 El A-2 ❑F-1 ❑F-2 ❑W ❑M -M
El Yes El No
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:
`El 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 `C1' No
Is the project located in the Floodplain?
Zone:
❑ Yes lNo
Are there wetlands on the property?
❑ Yes >r7 No
Is project associated with a nonconforming use or structure?
D Yes ❑ No
Does the project require sanitary?
Sanitary Permit # Public System:
# of bedrooms:
❑ Yes `"D No
Does the project require an affidavit? El LLC ❑ Trust
Affidavit #:
Number of Units:
Number of Bedrooms: �v=,
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):
El 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.
C 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:
1 17 E 6`r' Street
PO Box 403
Washburn, W1 54891
(715) 373-6109
i�cnr�i(tiva�l�:tytieldcounty_tvi,�v
Heal
Short -Term Rental Application Packet
This a > >lic:rtion packet contains inl�» matiott fora ���� �
I Short -Term Rental permit through Baylield County Planning, and
Zoning Department. Completed application can be marled/emailed to the address/email above.
SECTION A; ESTABLISHMENT INFORMATION
Establishment Name Establishment Tax ID N
Establishment Street Address City
1- I S uflu o oa d, (c,jol
SECTION B: OWNER INFORMATION _
Property Owner 1 Email Address
►��WQ� , lnC.
Owner Maili g Address City
o 1 �y �- 1, C�, ►-e..
SECTION C: IF OPERATING WITH PARTNER OR AGENT
Legal Licensee (partnership, I.LC', I,! P or Inc.) Email Address
Licensee Street Address City
Agent- Name (if applicable) f7naii Address —_-
Agent Street Address ys. City —
SECTION D: RENTAL UNIT INFORMATION see ke below
Unit th�it ID Structure Heating Water Sanitary Source
tae Source Source
- T_
4
Structure Type:
House (H) Diex (D) Cabin (C'
Heating Source:
Electric (F,') Natural Gas (NG) Pi
Water Source:
Public//Municipal (fj Private Well
it) of
) a± a O'
State Zip
1 d1
Phone Number
State flip
I Phone Number
- 7f
State
Irone Ntunber
State
Zip
of Stories
J
J of
Bedrooms
4
Bathrooms
2-
1
l (Y) A ailment (A) Condo (('O) Other (O), incase descrih'
n(j) Wood (W) fuel ('1
_.�Sanitary Source:
Public/Municipal (M
Other (O) please describe
____Private Onsite Wastewater Si
1,
1 tv
4 I (•'A),
'k .,