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Home My WebLink About26-0169` E7 117 E 6'" Street PO Box 403 Washburn, WI 54891 (715) 373-6109 permits�1bayfieldcountv.wi.goy oEC lVE- till JUN 1 1 2025 Ba field Co. Zonin t. Health Zoning $ '-YFIEYLD Submission # -4)(� Tee Paid Refund Permit # —o Date Issued $ Short -Term Rental Application Packet This application packet contains information for a Short -Tent 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 J / eer ! -c ICJ 6 • k44) . ( CA / Establishment Tax ID # flt % Town/City of EstablislunentStreetAd ress /3PD.s' #Crn City State Tip jr") 897 SECTION B: OWNER I1,FORMATION Pro erty P%vn r LL Email Address S a r' e n h `Sharon ' IGonsk,' c4cQ ao/Go,v7 Phone Number Z/iY IV-ga10 Owner Mailing Address /� / 6.7 S f seism mac( C, 9, hA State w/ Zip iW7V 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 ke below Unit Unit ID Structure Type Heating Source Water Source Sanitary Source # of Stories # of Bedrooms # of Bathrooms 1 rz P 3. 2 3 4 Structure Type: House Duplex CabC Yurt Apartment (A) Condo CO Other O please describe Heating rce: Electri Natural Gas G Pro a Wood Fuel Other (O), please describe Water cc: Public/Municipal Private W4') P Sanitary Source: Public/Municipal Private Onsite Wastewater S ste I Show location of: ❑ Driveways ❑ Frontage Roads (include name) 0 Existing Structures ❑ Well (W) ❑ Septic Tank (ST) ❑ Drain Field (DF) ❑ Holding Tank 0 Lake ❑ River ❑ Stream/Creek 0 Pond ❑ Flood lain ❑ Wetlands 0 Slopers over 20% N ' I S `Y v)` C\� j S � Setbacks from furthest extent iiwljiding eaves and County Use Only overhangs of structure to: pt ;St. ( r c' r't, Verified setbacks Road Centerline ft. ft. Notes/Comments: Front Lot Line/Right-of-Way ft. ft. Side Lot Line 1 ft. ft. (North East South West, circle one) Side Lot Line 2 ft. ft. (North East South West, circle one) Rear Lot Line ft. ft. Septic/Holding Tank ft. ft. Drainfield ft. ft. Privy ft. ft. Well f ' 1U" ft. ft. Existing Structure/Building ft. ft. Wetland ft. ft. Elevation of Floodplain ft. ft. Ordinary High -Water Mark (OHWM) y ft. ft. NOTE: Please indicate "see attached" on this page if submitting site plan as a separate document. ECEIVE D Site Plan 1111 JUN 1 1 2025 ept. Pi JUN 1 1 2025 Bayfield County Planning and Zoning Short Term Rental Pe&gold Co. Zoning Dept. PLANNING AND ZONING QUESTIONS I. 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, whichever is greater? f'Yes O No O Unsure 2. Is there a wetland located on the property? O Yes 0'No ❑ Unsure 3. Is there a floodplain located on or near the property? t 'Yes O No O Unsure 4. Is this project associated with any of the following: ❑ Rezone ❑ Conditional Use O Special Use O Variance 5. Did you contact the town to see if any ermits/re uirements apply to your project? O Yes O 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 byBayfield 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 4 units: $2,000 To ensure your application is complete and can be processed by the Department, check you have the following items: I�Applicant Information (Page 1) l?'Site Plan (Page 2) l2'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 retied upon by Bayfield 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 of inspection. Owner(s) or Authorized Agent Printed Name: �a ✓t q ro.� r, 'Ca.,� .,�/' Owner(s) or Authorized Agent Signature: Date: NOTE: If you are signing on behalf of the owner(s) a letter of authorization must accompany this application. 1 a' Bayfield o. Zoning Dept. ` s V .y/ m FIELD Heatlh- Periartwtenl- Heahhy people,communides 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 12 H Tourist Rooming House Water Analysis **Samples are ONLY accepted Monday -Thursday from 8am to 4pm** 1 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 ` DCeY I YOU 1 Phone p� ? r� \C)— 3 1— IJ3T, lJ Date Collected /H -�S Time Collected Circle One /im: 3v PM Facility Address I S city Collector's Name - N;-ewi'vi51G' Biling/Mailing Address City, State Zip Bacteria Sampling Point (Kitchen, bath sample tap, lake name, etc.) rh Nitrate Sampling Point (Kitchen, bath, sample tap, etc.) Reporting Method (check one) ElMail my results ❑Call NE -mail sU ;\/-or @ QoL (aysm Well Type (check one) 0 Drilled ❑ Jetted 0 Other 0 Driven Point 0 Dug Well Driller ID# (for new wells only) Well Construction Date Unique Well # (If known) Reason for Sampling (check one) ❑ Routine Sample ❑ Investigative ❑ Other C Real Estate Transaction FOR LABORATORY USE ONLY SamplelD#BAY o�l�pASOa Bac.eria Results (Total Coliform) Safe Unsafe Coli Absent ❑ E. Coll 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 Land Use Permit Application Review Checklist Submission #: 5TH— OUo?\`'\ Tax ID: (3fcw S -T -R: O— (o - 0 I Town: Dc l What zoning district is the project located in? ❑ R-1 ❑ R-2 ❑ R-3 ❑ R-4 R-RB ❑ C ❑ 1 ❑ M ❑ A-1 ❑ A-2 ❑ F-1 ❑ F-2 ❑ W ❑ M -M ❑ 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 No Is the project located in the Floodplain? Zone: ❑ Yes No Are there wetlands on the property? Yes 0 No Is project associated with a nonconforming use or structure? Yes 0 No Does the project require sanitary? Sanitary Permit #: ZUL1 a-�1 Public System: # of bedrooms: 0— ❑ Yes XNo Does the project require an affidavit? O LLC O Trust Affidavit #: Number of Units: I Number of Bedrooms: o� Number of Bathrooms: I Number of Stories: " 0 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: `l�W; 1v J Date of Approval: � Ip 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. I Short -Term Rental is for a maximum occupancy of I 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 LAND USE -X SANITARY - 367277 SPECIAL A - SPECIAL B/CONDITIONAL - BOA - BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION No. 26-0169 Tax ID: 13697 Issued To: DZIKONSKI, SHARON ARLENE & STANLEY JOSEPH Location: S07 - T46N - R07W Town of Delta Legal Description: DEER TRAIL LODGE EXPANDABLE CONDOMINIUM UNIT 12 TOG WITH UND INT IN COMMON ELEMENTS & LIMITED COMMON ELEMENTS V.1027 P.738 IM 2005R-498325 Residential Structure in R-RB zoning district For: [1 -Unit] Short -Term -Rental (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 4 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.