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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 El R-3 ❑ R-4 'El R-RB ❑ C ❑ I ❑ M ❑ A-1 ❑ A-2 ❑ F-1 ❑ F-2 ❑ W ❑ M -M
❑ Yes LI No
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:
❑ Yes LI 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 LI No
Is the project located in the Floodplain?
Zone:
❑ Yes El No
Are there wetlands on the property?
❑ Yes ,❑ No
Is project associated with a nonconforming use or structure?
IYes ❑ No
Does the project require sanitary?
Sanitary Permit # Public System:
# of bedrooms:
CC`Yes ❑ No
Does the project require an affidavit? ❑ LLC U1 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:
v'J V\' :
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.
L 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 6Ih Street
PO Box <103
Washburn, WI 54891
(71 5) 373-6109
'rrrnt.��rt_� �11aa.kk rrrarty'.�
p YFIELD
M
Health Zonin
Submission #
Fee Paid
Refund
Permit #
Date Issued
Short -Term Rental Application Packet
This application packet contains information for a Short -Tenn 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
1• stablishment Tax It) tt�I ow r /C,it1' oh'
(
IrCS tLr i�
-
Establishment Street Address — City —
State Zip
SECTION �� Co.f ! Utlt l�It� ( , C �t l �� (,c� f cl
SECTI N B: OWNER INF RMATION — ru
Property Owner Email Address — —
` Phone Number
i'_' ` lLf%(� ��� ,{,, �(/,��I�E, n —�l t4�(� I/{ �JrY � (a pp (-) , I a !`"/ti )17i i
Owner bailing Address — 1 —.
('it)' State lip
SECTION C: IF OPERATING WITH PARTNER OR AGENT
Legal Licensee t1»,rncr,hit , ,ii', ti.i', or tJTI email Address ,
` 1 hone Number
-f A _ l
Licensee Street Address — — _.
( State /.ip
Agent Name (ii' applicable) Email Address _ — ---
I Phone Number
AgentStrcelAddress — __
City State i %ip
SECTION!): RENTAL UNIT INFORMATION see key below) _
Unit IJnil ID Stricture Healing Water Sanitary source tl ofbtories oI' f, of
— I 'J') Source Source
— — Bedrooms Bathrooms
3
__� _ _ -
ur•
Sti'ncte Type: — —
Housc (1l) Duplex (D) Cabin (C') Yurt (Y) Apartment (A) Condo (CO) Other (()),please describe
Healing Source:
Electric (F) Natural Gas (N(;) Prtopane (P) Wood (W) fuel (P) Other O , please describe.
Water Source, — —_ ( )
`�anitar)' Source: — —
Pub lic;Municrpal (Ni) Private Well (f')_ Public/Municipal(M) Private Onsite 1�'nstetvater stem (P)
Site Plan
Show' location of-:
❑ Driveways ❑ Frontage Roads (include name) O Existing Structures L Well (W) U Septic Tank (Si) ❑ Drain Field (DI)
h.7 Holding 'lank (I -1'f) I 1 Lake I_I River 1.1 Stream/Creek O Pond ❑ Floodplain I Wetlands 7 Slopers over 20
N
Setbacks front furthest extent including caves and County Use Only
overhangs of structure to: Verified setbacks
Road Centerline fl. ftTJ Notes/Comments:
Front Lot .me 'Right of -Way It. h.
Side Lot Line I 1 h. It.
(North Fast South West, circle one)
Side lot Line 2 IX. ft.
(North Last South West, circle one) — —_-- — _ --
Rear Lot Line I ft. ft.
Sepuc`Holdnrg Dank ft'
— — ft_ — U
Draintiield Ifi, It.
Privy — — ft, ft. 1
- - -_ - -
Well ft. It.
L'xisting, Structure'Building ft, li.
Wetland Pt. It.
— _ —
F:1evation of Floodplain It. 1t.
Ordinary Iligh-Water Mark (()IIWM) T ft, it.
NOTE: Please indicate "see attached" on this page it'submittirtg site plan as a separate document.
2
Bayfield County Planning and Zoning Short -Term Rental Permit
PLANNING AND ZONING QUESTIONS
I. Is the property in the sltorcland, thin 300 feet of a river/stream OR land and side of tioodplain OR 1000 beet
— —_ _ age, whichever is greater? Cl Yes o ❑ Unsure
of a lake/ pond/floNvq
is there a wetland located of — ---—.�—_._—_
I
-t the property? D Yes f'No ❑ Unsure — — .
Is there a flood lain located on or near the pp 7crty? ❑ Yes No ❑ Unsure_—_
4. Is this project associated with any of the following: ❑ Rezone 11 Conditional Use ❑ Special Use —
❑ Variance
)id you contact the town to sec tf anits/requirements a to your pro 'ect'? ❑ Yes ❑ No
Zoning Department Use Permits: Short -Term Rental permits through Bayfield Count} Piano ing and toning Department
are nun -transferable, except as per the exemptions identified in ATOP 72.04(3). Short -Term Rental permits are regulated
by Bayfield County (_)rdinance Section 13-1-35.
APPLICATION FEES ($500 per unit)
Check or money order payable to Bayfield County Planning and Zoning
I unit: $50(I - j 2 unit~: $1,000 j3un1is : $1.500 2
I units : $_,OO0
in ensure your application is complete and can be processed by the Department, check you have the 1'61lowing items:
Applicant Information (Page I
❑ Site Plan (Page 2)
❑ I -loot' Plan(s) Provide sheet for each floor within each unit.
I (we) declare that this application, including any accompanying information, leas been exaurined by me (us) and to the
best oil nv (our) Iknovv ledge and belief it is true, correct, and complete, I (we) ackno' ledge that I (we) am (ace)
responsible lur the detail and accuracy of all intiirniafion that I (we) are providing and that will be relied upon by Bayfield
County in determining whether to issue a permit. I (we) further accept liability which may he a result ofBayfleld County
relying on this information I (we) are providing in or with this application. I (we) consent to count} otiicials charges) ith
administering, county ordinances to have access to tite above -described property at any reasonable time for the purpose of
inspection. rj
()\vner(s) or Authorized Agent Printed Name: /` (
Owner(s) or Authorized Agent Signature:
Date:,
NOTE: If you are signing on behalf of flue owner(s) a letter of authorization must accompany this application.
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