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117 E 511 Street, PO Box 58 Bayfield County Planning and Zoning Department
Washburn, WI 54891 LAND USE PERMIT APPLICATION
perm its (n@ bavfi eldco u ntv.wi.gov
County Use Only:
Submission #: w-6%
Permit#: '
Date:
SECTION A: General Information
Property Owner Name: .p s Aq, „ riz Agent a f licable):
I-td
Telephone Numbe : Telephone Number:
1.06(- A L - 8-1" V ld(Zt4t -.87=-
E-Mail Address: E-Mail Add es_ sb ;I01 ' s COmll
Mailing Address: M3ailing S rVSrfrl6. V41T Jts6
City, State, Zip: Di te, Zip: ).
x 4?3 ion W.
Contractor: Telephone Number: E-Mail Address:
SECTION B: Pro' ri y nformation
Project Address (if diCferen from m ilina address): '
Lk73D h etn F Ly\ama.Ka n LJ'U
Legal Desorption (if additional space is needed attach a separatesheet): w. Gouf lo'3itxt l. 3V P.IRS 304lrl¢3 04 a CSm go7 ,5 . at diWanl d
Section, Township, Ra ge: Town of. -
Tax ID #: aU4-( Lot Size (Acres/Square Feet):
EC - N.C: Project Information (check all t atL . 6
Project Use is: EA Residential Commercial Municipal
Project Type is: New Construction :W Addition/Alteration (existing structure)
Change Use (existing structure) Relocate (existing structure) RV Placement 2 1 + days
Sign Establishing a Business Temporary (12 or less months)
Shoreland Grading, Class A RV Placement 4+ months, Class A Other (describe):
required (Total sq ft): required
SECTION D:.Structure Information Does not a I to RVs and Signs, go to Section E
Structure hype is: Residence Principal Structure (describe):
Accessory Structure (describe): Shoreland Exempt Structure (describe): Mobile Home (provide manufactured
date):
Shipping Container Other (describe):
Foundation Type:
Basement Walkout Basement Slab V Crawlspace Ground Skids Other (explain):
Existing Structure: Length: 40 Width: -A0 Height: 1'A
Proposed Structure (Provide Sq Ft based on outside dimensions, including unfinished areas, attached garages/above grade
decks/ orches):
Basement Sq Ft: I g Floor Sq Ft: Loft Sq Ft: 2n' Floor Sq Ft: 3b Floor Sq Ft:
Garage Sq Ft: Porch Sq Ft: Deck Sq R44 Other Sq t (describe): Other Sq Ft (describe):
Total Sq Ft: xP Overall Height (finished grade to peak):
of Stories: Existing # of Bedrooms on property: Proposed # of Bedrooms in project:
SECTION E: RV and Sin Information check all that a 1 r) '
Sign is: R I is:
New Replacement New Replacement
On -premise Off -premise
1-sided 02-sided Year: Vin#:
On -building Multi -Tenant
Length: Width: Height: Make: Model:
3
SECTION F: Site Plan — attach a site plan or draw site plan in box below (See pages I & 2 of Land Use Permit Application
Information for information that is required to be provided on siteplan) -
Show location of:
Driveways Frontage Roads (include name) Existing Structures Well (W) Septic Tank (ST) Drain Field (DF)
Holding Tank (HT) Privy (P) Lake River Stream/Creek P000,nnJd; lloodplain Wetlands Slopes over20%
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APR 1(
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Zoning Dept
Setback or distance from furthest extent of structure
including eaves and overhangs to (include on site plan):
County Use Only
Verified setbacks
Road Centerline aco ft. ft. Notes/Comments:
0w 15
9^N
F2W M
Ti r
g , )a
the tC
Front Lot Line/Right-of-Way ft. ft.
Side Lot Line 1
North East South West, check one
Side Lot Line 2
orth East South West,check one Nj
ftf
Rear Lot Line ft. ft.
Septic/Holding Tank fl. ft.,pVo eC L
Drainfield fl. ft.
Privy fl. ft.
Well ft. ft.
Existing Structure/Building ft. ft.
Wetland fl. ft.
Elevation of Floodplain ft. ft.
Ordinary High -Water Mark (OHWM)
Other (describe) ft. ft.
SECT QN G, Additional Questions
Yes No Has the location of the proposed project including eaves and overhangs and the sanitary system and well been
staked? If no, what date will this be completed:
Yes W No Did a licensed surveyor mark lot line(s) if project is within 10 feet of re re etback? Seepage 2 of Land Use
Application Information for required setbacks.
Yes No Did property owner or applicant mark lot line(s) if project is within 3 et of re ui d e c&? S page 2 of
Land Use Application Information for required setbacks. CS
19 Yes No Is there an existing sanitary system on the property? If yes, what kind? I %
Drainfield Holding Tank Municipal/Public El Other (des
Yes Ili No Will pressurized water be installed in the structure? If yes, what kind of sanita
8se4qw II be installed or used
ept. to manage wastewater?
Drainfield Holding Tank Municipal/Public 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 Variance
Fee payment will be made via:
Check (attached) Cash (attached) debit/credit/echeck (department to call once payment is ready to be taken)
How would you like to receive your permit card?
Mail to: OR Email to:
Property Owner Address Agent Address Contractor Address Other (provide Name and Email or Address):
Section .H:.A.cknowled ement,andaS1 ature All
I 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.
1 (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 relied upon by Bayfield County in determining whether to
issue a permit. I (we) further accept liability which may be a result of Bayfreld County relying on this information I (we) are
providing in or with this application. 1 (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.
Q-t ha rOwner(s) or Authorized Agent Printed Name:
Owner(s) or Authorized Agent Signature: n Date: ! tat
NOTES:
1. If you are signing on behalf of the owner(s) a letter of authorization must accompany this application.
2. Specific conditions/instructions may be stated on the face of the issued Land Use Permits. Owners, agents, & contractors
must all be aware of permit details & conditions and permit card must be posted on property prior to start of project.
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Bayfield County
Impervious Surface Calculations
These calculations are REQUIRED per Wl Admin Code NR 115.05(1 )(e) and Section 13-1-32(g) and 13-1-
40(h) of the Bayfield County Code of Ordinances. The undersigned hereby makes application for construction,
reconstruction, expansion, replacement or relocation of any impervious surface within 300 feet of the ordinary
high water mark and agrees that all activities shall be in accordance with the requirements of the Bayfield
County Code of Ordinances and all other applicable ordinances and the laws of the State of Wisconsin.
Pursuant to Chapter 1, Title 13, Section 13-1-106(d) of the Bayfield County Zoning Ordinance(s), Planning and
Zoning Department employees assigned to inspect properties shall have access to said properties to make
inspections.
Property Owner(s):
6^llOhA(en.3<.^r\4Li^.la._, (Y\&(^ ^fi
Mailing Address:
13W S $>4-d^^'%i. AorAoo. LOi
Property Addre&s
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Legal Description:
J/4,.1/4,
Section, Township, Range
Sec C><^ _ Township t-t 2>JM, Range Olo W
Authorized AgenVCoiitroctor
(^^[ LOhatA^
Gov't Lot
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Lot #
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Vol & Page
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Lot(s)# | Block(s)#Subdivision Town of:
NAr >n
Parcel ID # (PIN #)
o4-o^-a~43-ol*'-o<»-«^ C^-oo3-l^6o
Tax ID #
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Date:
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Impervious Surface: An area that releases as runoff all or a majority of the precipitation that falls on it.
"Impervious surface" excludes frozen soil but includes rooftops, sidewalks, driveways, parking lots and streets
unless specifically designed, constructed and maintained to be pervious.
Calculation of Impervious Surface: Percentage of impervious surface shall be calculated by dividing the
surface area of existing and proposed impervious surfaces on the portion of a lot or parcel that is within 300
feet of the ordinary high water mark by the total surface area of the lot or parcel, multiplied by 100.
Impervious Surface Standard: Allow up to 15% impervious surface but not more than 30% impervious
surface on the portion of a lot or parcel that is within 300 feet of the ordinary high water mark. A permit can be
issued for development that exceeds 15% impervious surface but not more than 30% impervious surfaces with
a mitigation plan that meets the requirements of the Bayfield County Ordinance(s).
Existing Impervious Surfaces: For existing impervious surfaces that were lawfully placed when constructed
but that do not comply with the standards in Section(s) 13-1-32(g) and Section 13-1-40(h), the property owner
may do any of the following:
a. Maintenance and repair of all impervious surfaces:
b. Replacement of existing impervious surfaces with similar surfaces within the existing building footprint;
c. Relocation or modification of existing impervious surfaces with similar or different impervious surfaces,
provided that the relocation or modification does not result in an increase in the percentage that existed
on the effective date of the county shoreland ordinance, and meets the applicable setback
requirements in Section 13-1-32.
Impervious Surface Item Dimension Area (Square Footage)
Existing House
Existing Accessory
Building/Garage
Existing Sidewalk(s), Patio(s) &
Deck(s)
Existing Covered Porch(es),
Driveway & Other Structures
lc 2 y
Proposed Addition/House
Z r XProposedAccessory
Building/Garage
Proposed Sidewalk(s) & Patio(s)
Proposed Covered Porch(es) &
Deck(s)
6 rx fr.' G
Proposed Driveway
Proposed Other Structures
Total:
a. Total square footage of lot: _ l 3 1 " 9 i
b. Total impervious surface area: 2 N q
c. Percentage of impervious surface area: 100 x (b)/a = d
If the proposed impervious surface area is greater than 15% mitigation is required.
Total square footage of additional impervious surface allowed: @ 15% @ 30%
Issuance Information (County Use Only) Date of Inspection:
Inspection Rewrd:
Zoning District l 1
Lakes classification ( 1
Condition(s):
Stormwater
Management Plan Required:
Yes No
Signature of Inspector. Date of Approval:
ulforms/mpervioussurface
Created: May 2012 (®Apr 2016; Sept 2020) Proofed by:
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Letter of Authorization
Bayfdd County Pluming & Zoning Department
PURPOSL This Letter of Authorization is used to authorize a single property owner to act onbehalfofmultiplepropertyownersoradesignatedagenttoactonbehalfofthepropertyIfmultiplepropertyowners, each property owner must submit this signed letterover/
s. I,
10tYCrt property
owner), authorize 6AZ •"46n authorizedagent) to submit a vW%
U.!Pesidtn (Example: land use, special use, conditional use, rezone/map amenament appeal, variance, text amendment,etc. followingdescribedproject (Example: } for the p '
construction o residence or other structure, short-term rentalorotherusechange, etc.) . the
following described property:application
on my behalf for Legal
description of subject Property' Ca 'f^t *P a?
Ga ZO,*44d -4A G&*&f "IS) Mow y, 73d Address
of subject property: '%'%30 a k /M 4 e/ Ar
Signature
Dated
PJOG
i
Letter of Authorization
BayWd County Planning & Zoning Department
PURPOSE. This Letter of Authorization is used to authorize a single property owner to act on
behalf of multiple property owners or a designated agent to act on behalf of the property owners.
If multiple property owners, each property owner must submit this signed letter.
A g ge r(property owner), authorize ,G &//
authorized ) to . ' a UnA u6e. Sh i R dCnA le• land use, special
use, conditional • use, rezonehnap amendment, appeal, variance, text am ent, etc.) for the
following descrbed project (Example: construction of residence or other strucl ue, short-term
rental or other use change, etc.} application on my behalf for
the following described property;
Legal description of subject properly:]ed 69 rN 43 Rg 610 L-ot a, CS M -'go1y. b'' F. a (f a L&
M%A im Govt LA IN V. 1110 F.1 16 tire i3 Address
of subject property: 10
7,
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Land Use Permit Application Review Checklist
Submission #: I LA
What zoning district is the project located in?
111 R-2 R-3 R-4 R-RB C I M A-1 A-2 F-1 F-2 W M-M
Yes Imo Is lot substandard (does not meet current zoning dimensional requirements)?
Deed of record:
es No Is the project located in the Shorelands (Shorelands are lands within 300 feet of a river/stream OR
t landward side of floodplain OR 1000 feet of a lake/pond/flowage, whichever is greater)?
es []No Is impervious surface required? (Required if riparian lot OR lot is entirely within 300 feet of OHWM of
navigable waterway)
Yes ,Poo Is the project located in the Floodplain?
Zone:
es No Are there wetlands on the property?
Yes 4TNo is project associated with a nonconforming use or structure?
Yes JR:No Is project associated with a variance?
Case #:
Yes C;IrNo Is project associated with a Special B or Conditional Use Permit?
Permit #:
Yes o Is the project associated with a Special A Use Permit?
Yes J o Does the project require sanitary?
Existing New Intercept Reconnect Non -Plumbing Public
Sanitary Permit #:
Yes o Does the project require mitigation?
Implementation Deadline: Date of Compliance:
Yes 459do Does the project require an affidavit?
Affidavit #:
Yes o Did licensed surveyor mark lot line(s), if project is within 10 feet of required setback?
es No Did applicant/property owner mark lot line(s), If project is within 30 feet of required setback?
Project use is?`Residential []Commercial Municipal
Project type is? New Construction 'Addition/Alteration Change Use Relocate RV Placement Sign
Establishing a Business Temporary Shoreland Grading Other, describe:
Structure Type ise'='Residence Principal Structure Accessory Structure Boathouse (one story only)
Open-sided/Screened Structure (gazebo, etc.) Stairway to navigable waters Mobile Home
Shipping Container Other, describe
Total Sq. Ft. of Project: Number of Stories: Overall Height:
Calculated Fee Category:
Residential Principal Structures - $0.75/square foot (minimum $125)
Habitable Residential Accessory Structures - $0.50/square foot (minimum $75)
Non -Habitable Residential Principal and Accessory Structures -$0.20/square foot (minimum $75)
Commercial/Municipal Principal Structures - $0.75/square foot (minimum $125)
Commercial/Municipal Accessory Structures - $0.20/square foot (minimum $75)
Calculated Fee Amount: `t
Additional Fees: Return Inspection Land Use Revisions Special Use Permit- Class A After-the-Fact(ATF)
Floodplainhoreland -Impervious Surface Shoreland - Non -Conforming, etc. El Tower Siting/Collocation 1
El Tower Col ocation 2 f] Metallic Mine f
ATF Fee Amount:
Inspected by: Date of Inspection:
Lela N 2fCO9ie
Re -Inspected by: Date of Re -Inspection:
Denied by:
Reason for Denial:
Letter Mailed:
Approved by: Date of Approval:
Condition(s): 01
5 Must meet and maintain setbacks from furthest extension of structure including eaves and
overhangs.
For personal storage only.
Wor personal residence only.
Not for human habitation or sleeping purposes.
Town/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.
Uniform Dwelling Code (UDC) Permit from the locally contracted UDC Inspection Agency must be
obtained prior to the start of construction (if applicable).
C07--Use 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.
Sign must meet the requirements of Article E of the Bayfield County Zoning Ordinance.
To be constructed per plan.
Adhere to privy agreement.
Temporary permit allowing existing structure for a period of less than 1 year.
RV may not be used for permanent residence or storage.
RV allowed for
RV must be removed by
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).
and use permits shall be required for any new residence, any building or structure erected,
rre,.l,ocated, rebuilt, or structurally alteredkLandusepermitsshallbeobtainedpriorto 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:
P A,YFIELD Bayfield County
Planning & Zoning Department
117 E 5thStreet P.
O. Box 58 Washburn,
WI 54891 Phone:
715-373-6138 Fax:
715-373-0114 Property
Owner: Submission Number: WHALEN,
GAIL M LU-01592 13986
S ST CROIX RD GORDON,
WI 54838 Transaction Number: LIDMILA,
BEVERLY A LU-
01592-28E28 W4214
HEEsITOWN RD LOYAL,
WI 54446 MARTY,
MARY I S70
W34400 RD X EAGLE,
WI 53119 Description
Amount Verified
Fee Amount $0.00 Residential
Principal Structures - $0.75/square foot $252.00 minimum $
125) Total: $
252.00 Payment
Amount: $225.00 Reference:
1630 Paid
by: DANIEL W & GAIL M WHALEN,13986 S ST CROIX RD, GORDON, WI 54838
Payment
Type: Check Transaction
Date: undefined Receipt
of payment does not guarantee eligibility of permit
and is not proof of issuance of a permit.
B'FIELD Bayfield County
Planning & Zoning Department
117 E 5thStreet P.
O. Box 58 Washburn,
WI 54891 Phone:
715-373-6138 Fax:
715-373-0114 Property
Owner: Submission Number: WHALEN,
GAIL M AP-00021 13986
S ST CROIX RD GORDON,
WI 54838 Transaction Number: LIDMILA,
BEVERLY A AP-
00021-294C9 W4214
HEINTOWN RD LOYAL,
W154446 MARTY,
MARY J S70
W34400 RD X EAGLE,
WI 53119 Description
Amount Additional
Fee Amount 27.00 Total:
27.00 Pavment
Amount: 28.95 Reference:
3422208555 Paid
by: Gail Whalen Payment
Type: Debit Transaction
Date: undefined Receipt
of payment does not guarantee approval.
Town, City, Village, State or Federal
Permits May Also Be Required
Substandard — No / Nonconforming — No
Shoreland — Yes / Impervious Surface — Yes
Floodplain — No / Wetlands — Yes
Mitigation — No / Affidavit #:
LAND USE — X
SANITARY —
SPECIAL A —
SPECIAL B/CONDITIONAL —
BOA —
BAYFIELD COUNTY
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
No. 25-0177 Tax ID: 24475
Issued To: WHALEN, GAIL M; LIDMILA, BEVERLY A; MARTY, MARY J
Location: S09 - T43N - R06W
Town of Namakagon
Legal Description: LOT 2 CSM #807 V.5 P.262 (LOCATED IN GOVT LOT 3) IN V.736 P.195 355B
Residential Structure in R-1 zoning district
For: Addition/Alteration, Residence on a Crawlspace [336 Total sq. ft.]
Qti laimer) You are respouaible 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 Scott Roush
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. April 22, 2025
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.
For personal residence only.
Use best management practices to limit and prevent erosion during construction.
To be constructed per plan.
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
A Uniform Dwelling Code (UDC) Permit from the locally contracted UDC Inspection Agency must be obtained
prior to the start of construction (if applicable).