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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 El R-2 El R-3 El R-4 El R-RB El ❑I El OA -1 El A-2 ❑F-1 El F-2 El El M -M
El Yes '0 No
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:
❑ Yes Cl 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)?
El Yes) No
Is the project located in the Floodplain?
Zone:
El Yes °ENo
Are there wetlands on the property?
El Yes U.,No
Is project associated with a nonconforming use or structure?
❑Yes El No
Does the project require sanitary?
Sanitary Permit #: Public System:
# of bedrooms:
❑ Yes No
Does the project require an affidavit? El LLC ❑ Trust
Affidavit #:
Number of Units:
Number of Bedrooms:
Number of Bathrooms:
Number of Stories:
El 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.
El Check with Town regarding room tax.
❑.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:
17 E61h 1 PO Box 403et 13 4 (FIELD
Washburn, WI 54891
(715)373-6109
perrnits@bayfleldcoun,wi, ov
Health
Zoning
Submission #
Fee Paid
Refund
Permit #
Date Issued
Short -Term Rental Application Packet
This application packet contains information for a Short -Term Rental permit through BayfieId County Planning and
Zoning Department. Completed application can be mailed/etnailed to the address/email above,
SECTION A: ESTABLISHMENT INFORMATION
Establishn ent Name
Establis ment Tax ID #
Town/City of
Establishment Street Address
O S1 S o 1 A (4ii11,0( k.
City
F (�1 tJD
State
Wi
Zip
$411i
SECTION B: OWNER tFFOBMATION
PrQperty Owt er
L--1vko (vh A-
Email Address
L1✓r RDVtJt J @ C "((-.
Phone Number
1 lS - -�i �• t5Ss
Owner Mailing Address
2,1O r- 5th 44-
City
S Vl,PC1tu)rt.
State
Zip
SECTION C: IF OPERATING WITH PARTNER OR AGENT
Legal Licensee (partnership, LLC, LLP, or Inc,)
Email Address
Phone Number
Licensee Street Address
City
State
Zip
Agent Name (if applicable)
Email Address
Phone Number
Agent Street Address
City
State
Zip
SECTION
D: RENTAL UNIT INFORMATION (see key
below)
Unit
Unit ID
Structure
Type
Heating
Source
Water
Source
Sanitary Source
# of Stories
# of
Bedrooms
# of
Bathrooms
2
2
3
4
Structure Type:
House H Duplex (D) Cabin (C) Yurt (Y) Apartment (A) Condo CO Other (O), please describe
Heating Source:
Electric (E) Natural Gas (NG) Propane P Wood Fuel (F) Other (O), please describe
Water Source:
public/Municipal (M) Private Well (P)
Sanitary Source:
Public/Municipal M Private Onsite Wastewater System (P)
f !f
( >>y I
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