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Return to: County Use Only: 117 E 5'h Street, PO Box 58 Bayfield County Planning and Zoning Department Submission #:LLI—O05 Washburn, WI 54891 LAND USE PERMIT APPLICATION Permit if:_- permits@bayfieIdcounty.wj.gov Date: b .-SECTION A: General. information ..,. Property Owner Name: •ie Authorized Agent Name (if applicable): frlttylel Telephone Numb r: G4va Telephone Number: ��+er I G . i,nnyjvE-Mail Address: ;,r owl. E -Mail Address: Mir 287026 MailiAd r ss: Mailing Address: Sayge/d Plannin Co City, State, Zip: MIX0 �r 5yg54 City, State, Zip: 1128 Agency Contractor: ntl Lw Telephone Number: %v? E -Mail Address rfr 15-212 SECTION B: Property Information Project Address (if differenf,,frem m - ing address): 00 Leg at escri tion (if a itional spaces needed a separate sheet): (o O Section, Township, Range: Town of: Gtta,f Tax ID #: 12 Lot Siz Are Square Feet): 363 SECTIONC Pro_'ec4 nformatiop check,allthatapply) . ... Project Use is: Residential ❑ Municipal ❑ Commercial: If commercial, estimated cost of construction: $ Project Type is: ❑ New Construction ,$J Addition/Alteration (existing structure) El Change Use (existing structure) El Relocate (existing structure) O RV Placement 21+ days ❑ Sign 0 Establishing a Business 0 Temporary (12 or less months) horeland Grading, Class A ❑ RV Placement 4+ months, Class A ❑ Other (describe): required (Total sfi): required "SECTION D: Structure Information (Does not apply to RVs and Signs, go to Section E - - Structure Type is: ❑ Residence ❑ Principal Structure (describe): ❑ Accessory Structure (describe): O Shoreland Exempt Structure (describe): ❑ Mobile Home (provide manufactured date): El Shipping Container $1 Other (describe): ,.4. { � Foundation Type: ❑ Basement ❑ Walkout Basement El Slab ❑ Crawlspace ❑ Ground ❑ Skids El Other (explain): Existing Structure (ifaddition or alteration): Length: Width: Height: Proposed Structure (Provide Sq Ft based on outside dimensions, including unfinished areas, attached garages/above grade decks/porches): Basement Sq Ft: 1" Floor Sq Ft: Loft Sq Ft: 2"d Floor Sq Ft: 31 Floor Sq Ft: Garage Sq Ft: Porch Sq Ft: Deck Sq Ft: Other Sq Ft (describe): Other Sq Ft (describe): Z5$3 Total Sq Ft: 75 Overall Height (finished grade to peak): # of Stories: Existing # of Bedrooms on property: 3 Proposed i! of Bedrooms in project: 'SEQTION E: RV and Sign Information check all that apply) Sign is: 21, is: ❑ New ❑ Replacement El New ❑ Replacement ❑ On -premise ❑ Off -premise ❑ I -sided ❑ 2 -sided Year: Vin #: ❑ On -building ❑ Multi -Tenant Length: Width: Height: Make: Model: Application Page 1 F: Site Plan — attack a site plan or draw site plan in box below (See pages I Application Show location of: ❑ Driveways ❑ Frontage Roads (include name) ❑ Existing Structures ❑ Well (W) ❑ Septic Tank (ST) ❑ Drain Field (DF) ❑ Holding Tank (HT) ❑ Privy (P) ❑ Lake O River ❑Stream/Creek.❑Pond ❑Floodplain ❑Wetlands ❑Slopes over 20% 3, O Setback or distance from furthest extent of structure including eaves and overhangs to (include on site plan): Road Centerline Front Lot Line/Right-of-Way sb ft. Side Lot Line I L ft. (North East South West, circle one Side Lot Line 2 15 ft. (North Fast South West. circle one) MAY 2820?6 Bayfield Co. planning and Zoning Agency County Use Only Verified setbacks: ft. Notes/Comments: Ot ft. t OnFt✓txJb. 4 JaCdltl� ft. ft. S\rS 149 r�S 4v Ige ft. [t ct9Cil ft. Existing Structure/Building WJ P ft. ft. Wetland W ft. ft. Elevation of Floodplain K ft. ft. Ordinary High-WaterMark ft. ft. — v-& \/,\1l i t,° Other (describe) I ft. ft. P!t aL (R.t.IQl' 'Al .CAAreIriI, Application Page 2 SECTION C: jSdtfnal Questions ❑ Yes XNo Has the location of the proposed project, including eaves overhangs, the sagitary system and well, been staked? If no, what date will this be completed: Or9i vej 01dyMniu Note: The site will not be visited nor permit issued until after the staking date listed above. Yes ❑ No Did a licensed surveyor mark lot line(s) if project is within 10 feet of required setback? See page 2 of Land Use Application Information for required setbacks. 1% Yes ❑ No Did property owner or applicant mark lot line(s) if project is within 30 feet of required setback? See page 2 of Land Use Application Information for required setbacks. VQ Yes O No Is there an existing sanitary system on the property? If yes, what kind? ❑ Drainfield Holding Tank ❑ Municipal/Public O Other (describe): ❑ Yes No Will pressurized water be installed in the structure? If yes, what kind of sanitary system will be installed or used to manage wastewater? ❑ Drainfield ❑ Holding Tank ❑ Municipal/Public O Other (describe): ❑ Yes No Will sleeping occur in the structure? If yes, contact local Uniform Dwelling Code (UDC) for approval and inspection requirements. Is the project associated with any of the following: ❑ Rezone ❑ Class A Special Use ❑ Class B Special Use ❑ Conditional Use O Variance El not applicable Fee payment will be made via: Check (attached) ❑ Cash (attached) El debit/credit/e-check (department to call once payment is ready to be taken) How would you like to receive your permit card? 0Mail to OR$,Email to: ,J71'ISKy de,%MAilr:1t''t ❑ Property Owner Address O Agent Kddress ❑ Contractor Address O Other (provide name and e-mail or address): Section'H: Acknowledgement and Signature All Land Use Permits expire two (2) years from the date of issuance if construction or use has not begun. Sanitary permit issuance, if required, needs to occur prior to Land Use Permit issuance. Failure to obtain a permit or starting construction without a permit will result in penalties. The local Town, Village, City, State or Federal agencies may also require permits. The new construction of one- & two-family dwellings requires review and approval by the local Uniform Dwelling Code (UDC) authority. Additions and alterations to one- and two-family dwellings may require review and approval by the UDC authority. All municipalities are required to enforce the UDC. If subject property is part of a Condominium Plat, applicant hereby certifies and represents that applicant has all necessary approvals and recorded documents required to complete the project for which this permit is sought including requirements set forth in Wisconsin statutes pertaining to condominium associations, the Declaration of the Condominium Association in which the property is located, and all other rules, regulations and requirements pertaining to that Condominium Association. You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources wetlands identification web page, dnr.wi.gov/topic/wetlands, or contact a Department of Natural Resources service center (715)685- 2900. 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 believe 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 relied 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. 1 V,,O..t }fit;S KQetb1/ 1h. A4 Ut Owner(s) or Authorized Agent Printed Name: t t Owner(s) or Authorized Agent Signature: Date: g Z6 NOTES: I. If you are signing on behalf of the owner(s) a letter of authorization must accompany this application. 2. Specific conditions/instructions maybe stated on the face of the issued Land Use Permits. ORCllthbntractors must all be aware of permit details & conditions and permit card must be posted on property prior to start of project. THAI LU LULU Bayfield Co. Application Page 3 Planning and Zoning Agency 6/1/26, 4:00 PM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfield County Property Listing Today's Date: 6/1/2026 S Description Updated: 3/12/2025 Tax ID: 12397 PIN: 04-014-2-51-07-27-4 00.177-12000 Legacy PIN: 014112201015 Map ID: Municipality: (014) TOWN OF CLOVER STR: S27 T51N R07W Description: GITCHE GUMEE SHORES LOT 3 CSM #1880 IN V.11 P.118 (LOCATED IN LOTS 12 - 14) IN DOC 2025R-606637 Recorded Acres: 3.630 Calculated Acres: 3.630 Lottery Claims: 0 First Dollar: Yes Zoning: (R-RB) Residential -Recreational Business ESN: 109 Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 014 TOWN OF CLOVER 044522 SCHL-SOUTHSHORE 001700 TECHNICAL COLLEGE Property Status: Current Created On: 3/15/2006 1:15:14 PM a Ownership Updated: 3/12/2025 LAKESIDE MINONG LLC MINONG WI Billing Address: Mailing Address: LAKESIDE MINONG LLC LAKESIDE MINONG LLC PO BOX 35 PO BOX 35 MINONG WI 54859 MINONG WI 54859 11 Site Address * indicates Private Road 89005 BARK POINT RD HERBSTER 54844 ® Property Assessment Updated: 7/30/2018 2026 Assessment Detail Code Acres Land Imp. GS -RESIDENTIAL 2.000 132,800 132,900 G6 -PRODUCTIVE FOREST 1.630 1,600 0 2 -Year Comparison 2025 2026 Change Land: 134,400 134,400 0.0% Improved: 132,900 132,900 0.0% Total: 267,300 267,300 0.0% Property History -V. Recorded Documents Updated: 3/15/2006 ® WARRANTY DEED N/A Date Recorded: 2/21/2025 2025R-606637 O QUIT CLAIM DEED Date Recorded: 7/8/2014 20148.554938 1127-546 ® TERMINATION OF DECEDENT'S INTEREST Date Recorded: 9/20/2010 20108-534697 1047-254 ® CONVERSION Date Recorded: 501000 746-203;871- 1000;924-271 © WARRANTY DEED Date Recorded: 8/8/2005 2005R-501000 924-271 ® QUIT CLAIM DEED Date Recorded: 12/27/2002 2002R-478360 842-676 https://novus.bayfieldcounty.wi.gov/access/master.asp?paprpid=12397 1/1 Bayfield County, WI 61112026, 4:00:53 PM 1:1,050 Rivers --- Approximate Parcel Boundary Road Type — Town Lake Superior Shoreline Recession Segments '—' The average annual rate of bluff recession in this reach of shoreline is approximately 1.0 feet. Flood Plain Boundaries Active Dec 16th, 2011 0 0.01 0.03 0.05mi 1 1 I .' AE = Base floodplain where base flood elevations are provided. 0 0.02 0.04 0.08 km --- Lake Superior Proposed Setback Line Building Footprint 2015 Building eayilS Coony Land Bawds oeperanenl Bayfekl crony zoning Applipel on MIps:llmeptbeygeldmunlywLgovlzoning WAe/ 39005 BARK POINT RD X rch result v tH ;3 4 r wuN sf u rata` �►�y :S( T OlL.1..P_ `I 3 eta � - 'a.:.� M1 t 1 NERIOr NINONfi IC U,'i Tn IOI1t91 '5 L.yf`_ "s iic'l4 See. 183.0202 Wis. State State pgwrmont r ARTICLES OF ORGANIZATl E.'eared by the undersigned for the pa peso S ro n ing aW,scoosin I Article 1. Name ofthe limited liability company: Lakeside h5nong LLC Article2 The limited liability company Isorgan&e! Article 3. Name or the initial registered agent Kevin Brisky Articic4. Street address of the initial registered or 875 W Hokab St Minoog, WI 54859 United States of America Articles. managementofihe limited liability corm A manber or manbe s Articie6. Name and complete address of each orgo Kevin Brisky PO Bat 35 Mineng, KS 54859 United States of America Prema Brisky PO Box 35 Mmong, W 54859 United States of America Other Information This document was drafted by: Kevin Brisky Organizer Signature: Kevin Brisky Prema Brisky AFFIDAVIT OF AUTHORITY (Corporation, LLC, etc.) RECV9r JAN 032024 Bayfield Co. Planning and Zoning Age..ci 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: 1. Address of Subject Property: n , cJ0qoo$ 3 -ft ?o n4' Kb 2. The Subject Property is owned by: La1 Utz ,Y" Ned r LL C. - (Name of Company) y/n 3. The name(s) of the current President or Managing Member. V"V &9C, Lr 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. —2—ZoZN Dated: fflgefl Print Name `/ Subscribed and sworn to before me this ., Es day of 20 ,c �,,,(((n Iii NOTARY •••• A^ / % /j Notary Public, i c1 County, Wisconsin My commission:�EAA)r{5 /r/( 1. `• PUBLIC :•' ', For- tivls,` Fill','''', Land Use Permit Application Review Checklist Submission #: p or What zoning district is the project located in? ❑ R-1 ❑ R-2 ❑ R-3 ❑ R-4 tR-RB ❑ C ❑ 1 ❑ M ❑ A-1 ❑ A-2 ❑ F-1 ❑ F-2 ❑ W ❑ M -M ❑ Yes o Is lot substandard (does not meet current zoning dimensional requirements)? Deed of record: I ''es ❑ 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 o Is impervious surface requjred? (Required if riparian lot OR lot is entirely within 300 feet of O M of navigable waterway) ❑ Yes Aqo Is the project located in the Floodplain? Zone: ❑ Yes 1.MC Are there wetlands on the property? ❑ Yes ❑Mfo Is project associated with a nonconforming use or structure? ❑ Yes ❑4o Is project associated with a variance? Case #: ❑ Yes tij.4o Is project associated with a Special B or Conditional Use Permit? Permit #: ❑ Yes Lzm'IQo Is the project associated with a Special A Use Permit? ❑ Yes W-aa Does the project require sanitary? ❑ Existing 0 New 0 Intercept 0 Reconnect 0 Non -Plumbing O Public Sanitary Permit #: # of Bedrooms: ❑ Yes LIIIS Does the project require mitigation? Implementation Deadline: Date of Compliance: ❑ Y s CU Pd6 Does the project require an affidavit? Affidavit #: I2'Ye5 ❑ No Did licensed surveyor mark lot line(s), if project is within 10 feet of required setback? es 0 No Did a plicant/property owner mark lot line(s), if project is within 30 feet of required setback? Project use is? esidentia1 O Commercial ❑ Municipal Project type is? ❑ New Construction ddition/Alteration O Change Use O Relocate O RV Placement 0 Sign O Establishing a Business O Temporary 0 Shoreland Grading O Other, describe: Structure Type is: 0 Residence ❑ Principal Structure ❑ Accessory Structure O Boathouse (one story only) ❑ Open-sided/Screened Structure (gazebo, etc.) Q--S'{airway to navigable waters ❑ Mobile Home ❑ Shipping Container ❑ Oth r, describe Total Sq. Ft. of Project: Number of Stories: Overall Height: Fee Type Calculation Fee Amount ❑ Habitable Residential Principal and Accessory Structures - Enclosed Areas — all enclosed areas within dwelling except attached non -habitable garages $0.50 x sq ft (minimum $125) $ ❑ Dwelling Unenclosed Areas (decks, patios, etc.) or Attached Non -Habitable Garages $0.20 x s ft q (minimum $125) $ ❑ Non -Habitable Residential Principal and Accessory Structures $0.20 x _q s ft (mininyun $75) $ ❑ Commercial Principal Structures $250 + $0.005 x cost of construction (minimum $250) $ ❑ Commercial Accessory Structures $150 + $0.005 x cost of construction (minimum $150) $ ❑ Municipal Principal and Accessory Structures n/a $0 (exempt from fees) ❑ Return Inspection O Land Use Revisions ❑ Special Use Permit - Class A O Floodplain 0 Shoreland - Impervious Surface O Shoreland - Non -Conforming, etc. O Tower Siting/Collocation 1 0 Tower Collocation 2 O Metallic Mine ❑ After -the -Fact (ATF) $ Inspected by: I I ZQ%'t&f Date of Inspection: w Re -Inspected by: Date of Re -Inspection: Denied by: Date of Denial: Reason for Denial: Date Denial Letter Mailed: Approved by: Date of Ap rova : J Conditi (s): ust meet and maintain setbacks furthest extension of structure including eaves and overhangs. ❑ For personal storage only. ❑ For personal residence only. ❑ Not human habitation or sleeping purposes. own/State/DNR/Federal may require permitting ❑ A Uniform Dwelling Code (UDC) Permit from the locally contracted UDC Inspection Agency must be obtained prior to the start of construction. ❑ A Uniform Dwelling Code (UDC) Permit from the locally contracted UDC Inspection Agency must be obtjpe prior to the start of construction (if applicable). "tise best management practices to limit and prevent erosion during construction. ❑ This permit cannot be transferred if property is sold. ❑ A Bayfield County Health Dept permit is required. ❑ Check with Town regarding room tax. ❑ Short -Term Rental is for a maximum occupancy of persons. Sigust meet the requirements of Article E of the Bayfield County Zoning Ordinance. 1❑ 46 be constructed per plan. ❑ Adhere to privy agreement. ❑ Temporary permit allowing existing structure for a period of less than 1 year. 0 RV may not be used for permanent residence or storage. ❑ RV allowed for ❑ RV must be removed by 0 No sewer and pressurized water allowed in the structure. ❑ No plumbing or plumbing fixtures allowed. ❑ No additional sleeping areas allowed without obtaining necessary sanitary permit(s). ❑ Land use permits shall be required for any new residence, any building or structure erected, relocated, rebuilt, or structurally altered ❑ Land use permits shall be obtained prior to the initiation of construction or a change in land use ❑ Requirements (e.g., permits/licensing/tax) of Local Town, Village, City, State or Federal agencies are required ❑ Sanitation requirements must be met (if applicable) ❑ Additional conditions may be placed and need to be adhered to at the time of permit issuance Other Conditions: K: Applications and Forms/Applications/Land Use/Updated 2/25/2026 mdk BYFIELD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: Submission Number: LAKESIDE MINONG LLC, LU-02305 PO BOX 35 MINONG , WI 54859 Transaction Number: LU-02305-46B77 Description Amount Stairway to navigable waters $100.00 Total: $100.00 Payment Amount: $100.00 Reference: 6079 Paid by: Lakeside Minong LLC Payment Type: Check Transaction Date: 6/8/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. Town, City, Village, State or Federal Permits May Also Be Required Substandard — No / Nonconforming — No Shoreland - Yes / Impervious Surface - No Floodplain - No I Wetlands - No Mitigation - No I Affidavit #: LAND USE -X SANITARY - SPECIAL A - SPECIAL B/CONDITIONAL - BOA - BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION No. 26-0233 Tax ID: 12397 Issued To: LAKESIDE MINONG LLC Location: S27 - T51 N - R07W Town of Clover Legal Description: GITCHE GUMEE SHORES LOT 3 CSM #1880 IN V.11 P.118 (LOCATED IN LOTS 12 - 14) IN DOC 2025R- 606637 Residential Structure in R-RB zoning district For: Addition/Alteration, Stairway to navigable waters [75 Total sq. ft.] (Disclaimer): You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. Any future expansions or development would require additional permitting. Condition(s): See back of card NOTE: This permit expires two years from date of issuance if the authorized construction Emily Macgillivray 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. June 08, 2026 This permit may be void or revoked if any performance conditions are not Date completed or if any prohibitory conditions are violated. Condition(s): Must meet and maintain setbacks from furthest extension of structure including eaves and overhangs. Town/State/DNR/Federal may require permitting. Use best management practices to limit and prevent erosion during construction. To be constructed per plan.