HomeMy WebLinkAbout26-0287117 E 6a' Street
PO Box 403
Washburn, WI 54891
(715)373-6109
perm its:rabavtieldcounty.wi.gov
P YFIELD
Short -Term Rental Application Packet
This application packet contains information for both a Tourist Rooming House license through Bayfield County Healt
Department and a Short -Term Rental permit through Bayfield County Planning and Zoning DE4VEtJleted
application and applicable fees can be mailed/emailed to the address/email above. Establishment Tax ID can be found (o
through NOVUS(https://novus.bayfieldcounty.wi.gov/access/master.asn) JUN 1 12026
City of Washburn, City of Bayfield, Town of Pilsen: License through Bayfield County Health Qy t pnt is required.
Please review and fill out pages 1-4. Planning and Zoning Agency
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
Port Wing Association
Establishment Tax ID #
0
Town/City of
Port Wing
Establishment Street Address
81405 Orients Lake Rd.
City
Port Wing
we
WI
Zi
5465
SECTION I3: OWNERINEORMATIQN
Property Owner
J. Madison Properties LLC
Email Address
driftwoodproperties@hotmail.com
Phone Number
(612) 414-2226
Owner Mailing Address
18583 Pathfinder Dr.
City
Eden Prairie
State
MN
Zip
55347
SECTION C: IF OPERATING WITH.PARTNER'OR AGENT
Legal Licensee (partnership. LLC. LL', 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
I
H
E/P
P
P
2
2
2
2
3
4
Structure Type:
House (H) Duplex D Cabin (C) Yurt Y Apartment (A) Condo CO Other (O), please describe
Heating Source:
Electric E Natural Gas G Propane P Wood Fuel (F) Other (O), please describe
Water Source:
Public/Municipal M Private Well P
Sanitary Source:
Public/Municipal (M) Private Onsite Wastewater System (P)
0
Site Plan
Show location of:
❑ Driveways ❑ Frontage Roads (include name) ❑ Existing Structures ❑ Well (W) ❑ Septic Tank (ST) O Drain Field (DF)
❑ Holding Tank (HT) O Lake O River O Stream/Creek O Pond O Floodplain O Wetlands O Slopers over 20%
N
�>4
II
RECEIVED
JUN 112026
Bayfield co.
Planning and Zoning Agency
Setbacks from furthest extent including eaves and
County
Use Only
overhangs of structure to:
Verified setbacks
Road Centerline
ft.
R
Notes/Comments:
Front Lot Line/Right-of-Way
ft.
ft.
Side Lot Line I
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
15 ft.
ft.
Drainfield
ft.
ft.
Privy
ft.
ft.
Well 1)
14 ft.
ft.
Existing Structure/Building
ft.
ft.
Wetland (Lake)
175 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.
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.
> Bayfield 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 toaotttages, other than
hotels and motels, in which sleeping accommodations are offered for pay to ts. It does not
include private boarding or rooming houses not accommodating tourists or transients, or bed and breakfast
establishments regulated under Ch. ATCP 73. JUN 117026
> Wis. Stat. § 97.67 (5) and § 97.605 (1)(c) "No license may be issued untiLll pafiKda@tl&fees have been paid."
n'i ss 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:
O Summer O Winter ® Year -Round
Ill $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.
C# 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 an that for which it was collected (Wis. Stat. § 15.04 1 m .
Signature: Date:
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? ❑ Yes 0 No 13 Unsure
2.
Is there a wetland located on the property? ❑ Yes ll No 0 Unsure
3.
Is there a floodplain located on or near the property? ❑ Yes ❑ No IN Unsure
4.
Is this project associated with any of the following: ❑ Rezone ❑ Conditional Use ❑ Special Use
❑ Variance
5.
Did you contact the town to see if any ermits/r uirements apply to your project? ® Yes 0 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 -Tenn 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
I unit: $500 2 unit: $1,000 3 unit: $1,500 4 unit: $2,000
To ensure your application is complete and can be processed by the Department, check you have the following items:
RECEIVED
IE Applicant Information (Page I)
IN Site Plan (Page 2) JUN 112026
Cd Floor Plan(s) — Provide sheet for each floor within each unit.
Bayfield Co.
® Fees paid Planning and Zoning Agency
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. r,
Owner(s) or Authorized Agent Printed Na
Owner(s) or Authorized Agent Signature:
NOTE: If you are signing on behalf of t
5
Conceptual Main Level Floor Plan
Based on the listing and user -provided layout corrections. Not to scale.
LIVING ROOM
KITCHEN / DINING
BEDROOM I HALL I -Uff-F'L'I'
BEDROOM 2 HALL 2 neIRROOM
RECEIVED
JUN 112026
Bayfield Co.
Planning and Zoning Agency
Second Level Floor Plan RECEIVED
Conceptual layout (not to scale)
JUN 112026
Bayfield Co.
Planning and Zoning Agency
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.
RECEIVEDSTATE OF MINNESOTA )
) ss. ,;UN 112626
HENNEPIN COUNTY )
Bayfield Co.
The undersigned affirms and states as follows: planning and zoning Agency
1. Address of Subject Property: 81405 Orients Lake Road, Port Wing, WI_
2. The Subject Property is owned by: J. Madison Properties LLC
(Name of Company)
3. The name(s) of the current President or Managing Member: _Driftwood Properties LLC
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:
_Benjamin A. Wagner (rod
Properties LLC Predisent)_
Print Name
Subscribed and sworn to before me this ` l
day of 2Ic.
Not ry blic, Atv+ytcP`"t County, Minnesota
My commission: acv. t 1O d
GmyHettiPR Stark Notary PublicMinnesotaamn+r+.e�t«anvi�t.anm
Land Use Permit Application Review Checklist
Submission #: STEQ- 0035 D
Tax ID: Q
1Town:-4?6r4
S -T -R: t 5-4 1- b°1
Jr4lap,
What zoning district is the project located in?
❑ R-1 ❑ R-2 ❑ R-3 ❑ R-4 R-RB DC D 1 ❑ M ❑ A-1 ❑ A-2 ❑ F-1 ❑ F-2 OW DM-M
Yes O No
Does lot meet the zoning dimensional requirements or is it substandard?
Deed of record:
Yes O No
Is the project located in the Shorelands (Shore lands are lands within 300feet 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 #: ()7._G as Public System:
# of bedrooms: 3 cD °'1 halci�+�
Yes ❑ No
Does the project require an affidavit?'LLC ❑ Trust
Affidavit #:
Number of Units:
I
Number of Bedrooms: Z
Number of Bathrooms: Z.
Number of Stories: Z
❑ 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:
Date of Approval:
�O -Z3 -Z�
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 (�
)—dShort-Term Rental is fora maximum occupancy of 4 y persons.
Additional conditions may be placed and need to be adhered to at the time of permit issuance.
Other Conditions:
P YFIELD Bayfield County
Planning & Zoning Department
117 E 5w Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-0114
Property Owner:
J MADISON PROPERTIES LLC,
18583 PATHFINDER DR
EDEN PRAIRIE . MN 55347
Description
1 unit
Submission Number:
STR-00350
Transaction Number:
STR-00350-471387
Amount
$500.00
Total: $500.00
Payment Amount: $500.00
Reference: 151
Paid by: J Madison Properties LLC
Payment Type: Check
Transaction Date: 6/23/2026
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
Substandard
LAND USE - X
SANITARY - 07-92S
SPECIAL A —
SPECIAL B/CONDITIONAL—
BOA —
No. 26-0287 Tax ID: 25706
Issued To: J MADISON PROPERTIES LLC,
Location: S05 - T49N - R09W
Town of Orienta
BAYFIELD COUNTY
PERMIT
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
Legal Description: LOT 1 OF CSM #1214 FILED IN V.7 OF CSM P.303, LOCATED IN GOVT LOT 2 IN V.922 P.16 IM 2025R-
609166
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 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. June 23, 2026
This permit may be void or revoked if any performance conditions are not Date
completed or if any prohibitory conditions are violated.