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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?
El R-1 ❑R-2 ❑R-3 ❑R-4 ❑R-RB ❑C ❑I ❑M ❑A-1 ❑A-2 ,F-1 ❑F-2 ❑W ❑M -M
LI Yes ❑ No
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:,
'l 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)?
4f Yes ❑ No
Is the project located in the Floodplain?
Zone:
❑ Yes E No
Are there wetlands on the property?
LI Yes ❑ No
Is project associated with a nonconforming use or structure?
J Yes ❑ No
Does the project require sanitary?
Sanitary Permit # Public System:
# of bedrooms:
❑ Yes ti No
Does the project require an affidavit? ❑ LLC ❑ Trust
Affidavit #:
Numberof 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: :~ti
Date of Approval
Condition(s):
LI 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.
El 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 403
Washburn. WI 54891
(715) 373-6109
j jij thttyfle1 {c'C74.lilt . L. Gov
Health __!1'!&__
Submission # _ _,
Fee Paid �...�
Refund
Permit #
Date Issued
Short -Term Rental Application Packet
This application packet contains information Fora Short -Term Rental pennit through Bayfield County Planning and
Zoning Department, Completed application can he mailed/emailed to the address/email above.
SECTION A: ESTABLISHMENT INFORMATION
Establishment Name
_ _
Establishment Tax ID /City of
Establishment Street AdJrcss
i-ot
City State J2jip
iu G!C l/ . � _
J 8 l
SECTION B: OWNER INFORMATION
Property Owner Email ArlcIt'es I P lone Number
MJ(yf --7 (c- 7q 2 5 b l
Owner City State Zip
rMailing
rrAddress
,
✓ 4 0 CD C7 wM Li
SECTION C: IF OPERA'TING WITH PARTNER OR s
,� Address I Phone Number
Legal Licensee (partnership, 1,1C, 1.1,1, ur Inc.) Email
1. rT i 1 ,_'7' (-
Licensee Street Address City fState Lip
-i_
_n.I
Agent Name (if applicable) Email Address Phone Number
Agent Street Address City State %ip
SECTION B: RENTAL UNIT INFORMATION (see ke
below
unit
unit ID
Structure
Heating
Water
sanitary source
# of Stories
// of'
II of
Type
Source
Source
Bedrooms
Bathrooms
C
_
-z
d
Structure Type:
I -louse (H) Duplex (D) Cabin (C) Yurt (Y)_ Apartment (A) Cando (CO) Other (O),please describe
Heating Source:
Electric (E) Propane Wood W Fuel l�') Other O , Tease
Natural Gas (NG) p (P) ( ) ( ( describe
Water Source:
„--
Sanitary Source:
I uhhC/MIIniCPrivate (M) Well (P) I
Public/Municipal (M) Private Ollsite Wastewater System (P)
Site Plan
Show location of:
❑ Driveways ❑ Frontage Roads (include name) ❑ F.xisting Structures [ 1 Well (W) ❑ Septic Tank (ST) ❑ Drain Field (DF)
Li Holding Tank (I -IT) 0 Lake ❑ River ❑ Stream!C'reek ❑ Pond ❑ Floodplain ❑ Wetlands ❑ Slopers over 201,'o'
N
Setbacks from furthest extent including eaves and
overhangs of structure to:
Road Centerline ft.
Front Lot Line/Right-of-Way ft.
Side Lot Line I ft.
(North East South \West, circle one)
Side Lot I_,ine 2 ft.
(North East South West, circle one)
County Use Only
Verified setbacks
tt. Notes/Comments:
it.
It.
Rear t.ot Line It._----�� Ii,
Septidl-lolding 'lank ft, It.
Drainfield Ii. ft.
Pi iv\ lt,
Well It. ft.)
Existing StructuteButlding ft, ft. jp
Wetland ft. ft. „f '�!:< <
Elevation ation of Floodplain ft. ft.
(dium Please indicatetlattached on this page submitting ft.
JHigh-
NOTE:
"see attached" l l., site plan as a separate (IOCnlllent.
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 river/stream OR landward side of floodplain OR 1000 feet
of a Iake/pond/flowage, whichever is greater? '.Yes ❑ No ❑ Unsure
2, is there a wetland located on the
3
41.
❑ Yes to ❑ Unsure
Is there a tloodplain located on or near the property? ❑ Yes ❑ No Unsure
Is this project associated with any of the following: ❑ Rezone ❑ Conditional Use ❑ Special Use
❑ Variance
5. Did you contact the town to see if am
uirements apply to your project`? O Yes ❑ No
Zoning Department Use Permits: 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 PEES ($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
'l o ensure your application is complete and can be processed by the Depart't7ent, check you have the following items:
Cl Applicant Information (Page I
❑ Site Plan (Page 2)
❑ 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 1ayfield
County in determining whether to issue a permit. I (we) 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 oi'
inspection. / I
Owners) or Authorized Agent Printed Name:
Owners) or Authorized Agent Signature:
Date:
NOTE: I1' you are signing on behalf of the owner(s) a letter of authorization must accompany this application.
3
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