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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 Clf R-RB ❑ C ❑ I ❑ M ❑ A-1 El A-2 ❑ F-1 ❑ F-2 ❑ W ❑ M -M
❑ Yes 't�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)?
❑ Yes ;El No
Is the project located in the Floodplain?
Zone:
❑ Yes O. No
Are there wetlands on the property?
❑ Yes .ate, No
Is project associated with a nonconforming use or structure?
lYes ❑ No
Does the project require sanitary?
Sanitary Permit #: Public System:
# of bedrooms:
LYes ❑ No
Does the project require an affidavit? ❑ LLC Q 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: .:
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.
LI 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 1- 6`a' Street
PO Box 403
Washburn, WI 54891
(715) 373-6109
1 c�s tl7 lw a t�� ,}� l wlci�xrt,tatty. i gov
R YFIELD
1
Health Zoning
Submission # ___ l
Fee Paid
Refund
Permit #
Date Issued
Short -Term Rental Application Packet
This application packet contains information fora Short -Term Rental permit through Bayfreld County Planning and
Zoning Department. Completed application can be mauled/entailed to the address/email above.
SECTION A: ESTABLISHMENT INFORMATION
1✓stablishnlent Name
Establishment ['ax ID #
I'ovy /C'ity of
d ro
_% u
Establishment Street Address
(*q 15 wow a tr iv
City
C{aI
I St
State I Zip
I ln/ jSV92-!
SECTION B: OWNER INFO MATION _
Propert Owner Entail Adch•ess Phone Number
C'( -/(w- yizU ', -__1(v __0
Owner Mauling Address Caty
_
State zip
)../
SECTION C: IF OPERATING WITH PARTNER_ OR AGENT
Legal Licensee (partnership. LIA', 1.LP, or Inc I,Itlail Address Phhopne Number
Licensee Street Address Cria'
Stdtl', 71�
( J
Agent Name (if applicab e) Email Address I
Phone Number
Agent Street Address
C h'
it
State 7,t
SECTION D: RENTAL UNIT INFORMATION see ke
below)__
Unit ID Structure
Heating
Water
—Unit
Sanitary Source ,4 of Stories
# of
tf of
T pe
Source
Source
:i:
Bedrooms I Bathrooms
titi
iiii
_—iiiii
m,
4
Structure Type:
[louse (I I)Duplex (D) Cabin (C) Yuri) A mhnent (A) Condo (CO) Olher_(O , lease describe
Heating Source: —
Electric, (E) Natural Gas(NG) I'ropanc(P) Wood (W) Fuel (F) Other (O), ase describe
Water Source:
Sarulary Source:
Public/Munici tat M Private Well (P) Public/Municipal ('M) Private Onsite Wastewater System (P)
\ t t
j �Ix
Hayfield County Planning and Zoning Short -Term Rental Permit
`PLANNING AND ZONING QUESTIONS
1. Is the property in the shoreland, within 300 feet of a river/stream OR landward side of floodplain OR 1000 feet
of a lake/pond/flowage, whicheve► is greater? Yes ❑ No ❑ Unsure
2. Is there a wetland located on the properly`? 0 Yes 'KNo ❑ 1Insure
3. Is there a floodplain located on or near the property? ❑ Yes ..No O Unsure
4. Is this project associated with any of the following: ❑ Rezone ❑ Conditional Use ❑ Special Use
❑ Variance
5. Did you contact the town to see if any permits/rccquirements app y to your project? ❑ Yes ❑ No _
Zoning Department Use Permits: Short -Term Rental permits alt►'ouf;h Hayfield 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 Hayfield 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 3 units : $1,500 1 4 units : $2,000
To ensure your application is complete and can be processed by the Department, check you have the following items:
Lii Applicant Information (Page 1
❑ 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) ant (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 I3aytield County
relying on this information I (we) are providing in or with this application. I (ewe) 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. /I _
Owncr(s) or Authorized Agent Printed Name: (7(� t�
Owner(s) or Authorized Agent Signature: - i _ i Dale: "
NOTE: If you arc signing on behalf of the owner(s) a letter of authorization must accompany this application.
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