HomeMy WebLinkAbout26-0263117 E 6'" Street
PO Box 403
Washburn, WI 54891
(715) 373-6109
permits(aibavfi eldcountv.wi. gov
I3 L YFIELD
MAR 2 g 2u1o"
,.,.... I..
Short -Term Rental Application Packet
Health
Zoning
Submission#
e21i
Fee Paid
b'> 0
jO,00
Refund
Permit #
DateIssued
h -d a.
This application packet contains information for both a Tourist Rooming House license through Bayfield County Health
Department and a Short -Term Rental permit through Bayfield County Planning and Zoning Department. Completed
application and applicable fees can be mailed/emailed to the address/email above. Establishment Tax ID can be found ENTER
D
through NOVUS(httns://novus.bavfieldcountv.wi.gov/access/master.asp)
City of Washburn, City of Bayfield, Town of Pilsen: License through Bayfield County Health Department is required.
Please review and fill out pages 1-4.
All Other Towns: A license through the Health Department and permit through the Planning and Zoning Department are
required. Please review and fill out pages 1-5.
SECTION A: ESTABLISHMENT INFORMATION
Establishment Name
h+kills L'Ata- Else
Establishment Tax ID #
Town/City. of
G ru�A• Vie w
Establishment Street Address
q?ovii Gr.u\e P-
City
Gib le
State
ws
Zip
5 y_a
SECTION B: OWNER INFORMATION
Proper-ty Ow er Arrns�, jk
/ �j'�ltln�-�ir
Email Address 1 �7
Jk5� i n, 5'CAIn 1T(!r%o 1'
Phone Number
66S-6 o6 S1( 7
Owner Mailing Address
TDDtl Alp 4k l&4K
City
is[ a .Mo�� Ls
State
z
Zip
3 17
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
1
R
e
P
P
2
_
D•S
2
3
4
Structure Type:
House Duplex (D) Cabin (C) Yurt Apartment (A) Condo CO Other (0), please describe
Heating Source:
Electric (E) Natural Gas G Propane Wood Fuel (F) Other (0), please describe
Water Source:
Public/Municipal Private Well (P)
Sanitary Source:
Public/Municipal Private Onsite Wastewater System
Bayfield County Health Department — State Lodging License
Health Department (State Lodging License): All rental units require a Tourist Rooming House license through the State
of Wisconsin Department of Agriculture, Trade and Consumer Protection (WDATCP) or their authorized agent (Bayfield
County Health Department.
> Bayfield County Health Department issues permits on behalf of the State of WDATCP under ATCP 72, 73, 76,
78 and 79.
➢ ATCP 72 regulates lodging facilities including hotels, motels and tourist rooming houses.
➢ Baytield County Ordinance Title 9 — Chapter 2 Food Protection, Lodging, Pools, Campgrounds.
Recreational/Educational Camps, Tattoo and Body Piercing Establishments outlines the licensing program and the
authorized agent agreement between the Bayfield County Health Department and the State of Wisconsin.
> ATCP 72.03(20): "Tourist rooming house" means all lodging places and tourist cabins and cottages, other than
hotels and motels, in which sleeping accommodations are offered for pay to toul;qIt does not
include private boarding or rooming houses not accommodating tourists or transieiTfs, or be and breakfast
establishments regulated under Ch. ATCP 73. MAR 2 6 ZOZ6
> Wis. Stat. § 97.67 (5) and § 97.605 (1)(c) "No license may be issued until all appligpifegos have been paid."
Planning and Zoning Agency
> Wis. Stat. § 97.605 (1)(a) "No person may conduct, maintain, manage or operate a hotel, restaurant,
temporary restaurant, tourist rooming house, vending machine commissary or vending machine if the
person has not been issued an annual license by the department or by a local health department that is
granted agent status under s. 97.615 (2)."
> Within 30 days after receiving a complete application for a license, the department or its agent shall either
approve the application and issue a license or deny the application. If the application for a license is denied,
the department or its agent shall give the applicant reasons, in writing,for the denial.
> A license shall not be issued to an operator without prior inspection.
> Tourist rooming houses license expires on June 30'h. ATCP 72 requires an annual renewal application and fee.
Failure to maintain proper permitting will result in penalties. Licenses are non -transferable, except to immediate
family members as allowed in ATCP 72.
APPLICATION FEES — Required for all tourist rooming. house within Bayfield County
Check or money order payable to Bayfield County Health Department
When will your rental be in operation:
❑ Summer ❑ Winter l'Year-Round
❑ $586.30 — License Fee ($286.30 (County fee: $272, State fee: $14.30)) + Pre -Inspection Fee ($300)
Pre -Inspection Fee includes bacteriological sample analysis for private drinking water supply.
❑ Rush Fee ($50) — A one-time $50 rush fee will be charged for inspections requested within 7 business days.
However, depending on scheduling, staff may not be able to accommodate all rush requests.
Your signature below will acknowledge you have received information as to where to obtain a copy of the code and
will comply with applicable Wisconsin Administrative Code(s). Personally identifiable information you provide may be
used for purposes other than that for which it was collected (Wis. Stat. § 15.04 1 m) .
Signature: Date:3// / /�
Bayfield County Planning and Zoning Short -Term Rental Permit
PLANNING AND ZONING QUESTIONS
1.
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? Gd'Yes ❑ No ❑ Unsure
2.
Is there a wetland located on the property? ❑ Yes O No Ef Unsure
3.
Is there a floodplain located on or near the property? O Yes O No 9Unsure
4.
Is this project associated with any of the following: O Rezone ❑ Conditional Use O Special Use
❑ Variance
5.
Did you contact the town to see if any ermits/re uirements apply to your project? O Yes ISNo
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
by Bayfield County Ordinance Section 13-1-35.
APPLICATION FEES
Check or money order payable to Bayfield County Planning and Zoning
1 unit : $500 2 unit: $1,000 3 unit: $1,500 4 unit: $2,000
P'cmffVMi i
To ensure your application is complete and can be processed by the Department, check you ha e e t5liowmg tems:
❑ Applicant Information (Page 1) MAR 262026
❑ Site Plan (Page 2) Bayfield Co.
❑ Floor Plan(s) — Provide sheet for each floor within each unit. Planning arc Z_• ng a.^ency
O Fees paid
I (we) declare that this application, including any accompanying information, has been examined by me (us) and to the
best of my (our) knowledge and belief it is true, correct, and complete. I (we) acknowledge that I (we) am (are)
responsible for the detail and accuracy of all information that I (we) are providing and that will be relied upon by Bayfield
County in determining whether to issue a permit. I (we) further accept liability which may be a result of Bayfield County
relying on this information I (we) are providing in or with this application. I (we) consent to county officials charged with
administering county ordinances to have access to the above -described property at any reasonable time for the purpose of
inspection. I, S��
��A$ N
Owners) or Authorized Agent Printed Name: ar-
Owner(s) or Authorized Agent Signature:
Date: 3/1a/ 26
NOTE: If you are signing on behalf of the owner(s) a letter of authorization must accompany this application.
Site Plan
Show location of:
❑ Driveways ❑ Frontage Roads (include name) ❑ Existing Structures ❑ Well (W) ❑ Septic Tank (ST) ❑ Drain Field (DF)
❑ Holding Tank (HT): ❑ Lake ❑ River ❑ Stream/Creek ❑ Pond ❑ Floodplain ❑ Wetlands. U. Slopers over 20%
N
52� G��-�Llne
RECEIVED
MAR 262026
Bayfield Co.
Planning 'cc'ng 7ency
Setbacks from furthest extent including eaves and
overhangs of structure to:
County Use Only
Verified setbacks
Road Centerline
63 6
ft.
ft.
Notes/Comments:
Front Lot Line/Right-of-Way
ft.
ft.
Side Lot Line 1
(North East South West, circle one)
ft.
ft
Side Lot Line 2
(North East South West, circle one)
ft.
ft
Rear Lot Line
ft.
ft.
Septic/Holding Tank
ft.
ft
Drainfield
ft.
ft.
Privy
ft.
ft
Well
ft.
ft.
Existing Structure/Building
ft.
ft.
Wetland
ft.
ft.
Elevation of Floodplain
ft.
ft.
Ordinary High -Water Mark (OHWM)
ft.
ft.
NOTE: Please indicate "see attached" on this page if submitting site plan as a separate document.
A4 -V.-5 Li' -e
M
RECEIVED
MAR 262026
hayfield Co.
planning?`r , �[_nln9.'A9enay
F.ECEIVtD
MAR 26 2026
sayfield Co.
Planning and Zcr;n9 Agency
FlOO.2
FlOOR1
48025 Old Grade Rd, Cable, Wl 54821 Floor piansrtourcannot be used for buiidingor design purposes. Shen end dimensions are approalmate.
Land Use Permit Application Review Checklist
Submission #: S t - 0033
Tax ID:
K
S -T -R: ≥o-1jy-S
Town: (7fo.nd view/
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 XNo
Is the project located in the Floodplain?
Zone:
Yes ❑ No
Are there wetlands on the property?
❑ Yes No
Is project associated with a nonconforming use or structure?
%Yes ❑ No
Does the project require sanitary?
Sanitary Permit #: a— Ui S Public System:
# of bedrooms: 3
Does the project require an affidavit? ❑ LLC 0 Trust
❑ Yes No
Affidavit It:
Number of Units:
Number of Bedrooms:
Number of Bathrooms:
Number of Stories:
❑ After -the -Fact (ATF)
ATF Fee Amount:
�
Inspected by: txS 1 t e W \nS/ 1
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: ns
Date of Approval: ( _ �� �r
_
�J avl
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. r�
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:
I3 kYFIELD Bayfield County
Planning & Zoning Department
117E 5th Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-0114
Property Owner:
STAUFFER, JUSTIN J & AMANDA B
3006 NORTH RD
BLUE MOUNDS, WI 53517
Description
I unit
Submission Number:
STR-00332
Transaction Number:
STR-00332-457FF
Amount
$500.00
Total: $500.00
Payment Amount: $500.00
Reference: 0003756721
Paid by: CK # 0003756721
Payment Type: Check
Transaction Date: 6/15/ 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
Shoreland ,Wetlands
LAND USE -X
SANITARY - 21-182S
SPECIAL A —
SPECIAL B/CONDITIONAL —
BOA —
No. 26-0263 Tax ID: 16348
Issued To: STAUFFER, JUSTIN J & AMANDA B
Location: S20 - T44N - R05W
Town of Grand View
BAYFIELD COUNTY
PERMIT
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
Legal Description: LOT 1 OF CSM #935 V.6 P.151 BEING A PAR IN GOVT LOT 8 (TOG WITH DRIVEWAY) IN DOC 2025R-609634
Residential Structure in R-1 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 6 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. June 17, 2026
This permit may be void or revoked if any performance conditions are not Date
completed or if any prohibitory conditions are violated.