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HomeMy WebLinkAbout26-01703ern 117E 6'" Street �Y ELD Health Zoning PO Box 403 Submission # Q 7$ Washburn, WI 54891 Fee Paid (715) 373-610 (J 2 \\ V Refund permits(albavfieldcoun i. v LS D Ep)TEREO Permit # - on o 3 J 0 2025 /I a 5 Date Issued Ull UN Bavfield Ct9 Rental Application Packet This application packet contains information for a Short -Term 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 I Establishment Tax ID # I Town/City of X31? r n`, Establishment Street Address City ate Zip -y (Y\ el. -r -o' S b d.I _ SECTION B: OWNER INFORMATION Property OwnOwne,j Email Address Phone Number Src r&c (_LL \3 0 Qnscnt \prc coot --) Owner Mailing Address ity S to Zip SECTION C: IF OPERATING WITH PARTNER OR AGENT Legal Licensee (partnership, LLC, LLP, or Inc.) Email Address J Phone Number rr tAi, O `ll ob3 7&'. LicenseeStreet Address I CityStateI Zip 9v 3 Q / (a i f ,a9,,� ,t D I ____ Agent Name (if applicabl fl -1 Email Address Phone Number rct m r> e l3 a h�o `-115 -O- 7(a Agent Street Address City State Zip /aS-S S' a S� S nvt r I �73 SECTION D: RENTAL UNI INFORMATION (see Ice below) Unit Unit ID Structure Heating Water Sanitary Source # of Stories # of # of TypeSource Source Bedrooms Bathrooms 2 3 4 Structure Type: House Duplex (D) Cabin (C) Yurt (Y) Apartment (A) Condo CO Other (0), please describe Heating Source: Electric (E) Natural Gas G Propane P Wood Fuel Other (0), please describe Water Source: I Sanitary Source: Public/Municipal (M) Private Well (P) Public/Municipal M Private Onsite Wastewater System (P) VA FIELD HeaLtw De o s -h t.evt,f— Healthy people, communities and environment for a superior Bayfield County. Environmental Health Drinking Water Laboratory Bayfield County Health Department 117 E. Sixth St., P.O. Box 403 Washburn, WI 54891 (715) 373-6109 Department Use Only Date/Time Received: Amount Paid: T it Tourist Rooming House Water Analysis **Samples are ONLY accepted Monday -Thursday from 8am to 4pm** • Check tests desired • Each test is $25 Checks may be made out to Bayfield County Health Department (BCHD) • Sample collection instructions are on the back of this form All Samples MUST be submitted within 24 hrs AND delivered on ICE. Please note sample results will be kept on file for 5 years Sample Collection Information (Please Print) Bacteria (E-Coli) Surface Water or Quantification (Coliform/E-Coli Count) Nitrates (MUST bring in on ice) Facility Name Sereln�� on /fie ©wen Phone GIs-g3_gUOr*' Date Collected to-�± Time Collected Circle One i'a'S3 AM Facility Address City co.bu- btors ollecName (�ii�W�YISkr' . Biling/Mailing Address ____ City, State Zip Bacteria Sampling Point (Kitchen, bath sample tap, lake name, etc.) &1X{ Nitrate Sampling Point (Kitchen, bath, sample tap, etc.) Reporting Method (check one) ❑ Mail my results ❑ Call 'E-mail t Fi n Cwt ' I\" p k ° Corn Well Type (check one) ❑ Drilled ❑ Jetted U Other ❑ Driven Point U Dug Well Driller ID# (for new wells only) Well Construction Date Unique Well # (If known) Reason for Sampling (check one) ❑ Routine Sample ❑ Investigative ❑ Other ❑ Real Estate Transaction FOR LABORATORY USE ONLY Sample ID#BAY 1t IL{ S (L Bacteria Results (Total Coliform) Safe Unsafe %E. Coli Absent ❑ E. Coli Present Sample ID# BAYN Nitrate Result: ❑ SAFE ❑ UNSAFE — Exceeds Health Advisory Limit of 10 mg/L MDL: (Minimum detection limit for laboratory) Notes: Wisconsin DATCP Laboratory Certification Number 277579-D3 Lab ID Number 105-486 Certified by Wisconsin DNR under NR 149 Laboratory ID# 804075250 AFFIDAVIT OF AUTHORITY (Corporation, LLC, etc.) PURPOSE. This Affidavit of Authority is used to certify the individual applying for a permit is authorized when the property is owned by a corporate/business entity. STATE OF WISCONSIN ss. BAYFIELD COUNTY The undersigned affirms and states as follows: 45580 Metro's Landing 1. Address of Subject Property: SOLO PROPERTIES LLC 2. The Subject Property is owned by: (Name of Company) 3. The name(s) of the current President or Managing Member: Roseann Pepsnik. Bob Kirby, Bruce Berger (managers) 4. I certify that the company named in paragraph 2 is valid and in effect on the date signed below. I am the duly appointed agent of the Company named above in paragraph 2, and I have the authority under the terms of said authorization to apply for permits from the Bayfield County Zoning Department concerning the Property described in paragraph 1. I further certify that the information and statements made within this affidavit are true, accurate, and complete to the best of my knowledge. 5. I am authorized by the above -named Company to apply for and bind the Company to the terms and conditions of any permit that may be issue by the Bayfield County Zoning Department. 6. By signing this affidavit, I attest that I am unaware of any known or unknown person(s) who would contest this application. I agree to indemnify Bayfield County or such person or legal entity suffering a damage resulting from any illegalities of the application for permit. Dated: 3 /- " Roseann Pepsnik Print Name Subscribed and sworn to before me this 31 day of r h 2O. HOLLY CHRISTENSEN Notary Public State of Wisconsin Notary Public, ct County, Wisconsin My commission: 2xf r re S 3-11-17 Land Use Permit Application Review Checklist Submission #: 7 a-- 4 S Tax ID: Sb 3l(p S -T -R: DS - £(3_ O"1 Town: CGL What zoning district is the project located in? ❑ R-1 ❑ R-2 ❑ R-3 ❑ R-4 R-RB ❑ C ❑ I El M ❑ A-1 ❑ A-2 El F-1 ❑ F-2 ❑ W El M -M El Yes,'No Does lot meet the zoning dimensional requirements or is it substandard? Deed of record: (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 UNo Is the project located in the Floodplain? Zone: ❑ Yes CNo Are there wetlands on the property? ❑ Yes )4 No Is project associated with a nonconforming use or structure? EYes El No Does the project require sanitary? Sanitary Permit #: aO -. i (a S Public System: # of bedrooms: 5 Yes ❑ No Does the project require an affidavit? `XLLC ❑ Trust Solo e, i S LZC,. Affidavit #: Number of Units: I Number of Bedrooms: 4-j Number of Bathrooms: 3 Number of Stories: El After -the -Fact (ATF) ATF Fee Amount: Inspected by: - S � Date of Inspection: Inspection Notes: — �ev�ov5 1f1-0(54 Re -Inspected by: Date of Re -Inspection: Denied by: Date of Denial: Reason for Denial: Date Denial Letter Mailed: Approved by:K pc t-J� \tYv�'J V 1 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. ❑ Check with Town regarding room tax. 1 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: Town, City, Village, State or Federal Permits May Also Be Required Shoreland LAND USE — X (previous 17-0154) SANITARY - 20-196S SPECIAL A — SPECIAL B/CONDITIONAL — BOA — No. 26-0170 Tax ID: 8396 Issued To: SOLO PROPERTIES LLC, Location: S05 - T43N - R07W Town of CABLE BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION Legal Description: PAR IN GOVT LOT 1 IN V.1149 P.970 106B Residential Structure in R-RB zoning district For: [1 -Unit] Short -Term -Rental, Maximum Occupants Allowed is 10 (Disclaimer): Any future expansions or development would require additional permitting. Condition(s): Town may require permitting. Short -Term Rental is for a maximum occupancy of 10 persons. NOTE: This permit expires two years from date of issuance if the authorized construction Desi Niewinski work or land use has not begun. Authorized Issuing Official Changes in plans or specifications shall not be made without obtaining approval. This permit may be void or revoked if any of the application information is found to have been misrepresented, erroneous, or incomplete. May 12, 2026 This permit may be void or revoked if any performance conditions are not Date completed or if any prohibitory conditions are violated.