HomeMy WebLinkAbout26-0358117 E 6a' Street
PO Box 403
Washburn, WI 54891
(715) 373-6109
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--YFIELD
Health
Zoning
Submission #
TR-00292
Fee Paid
Refund
Permit #
Date Issued
as
Short -Term Rental Application Packet
This application packet contains information for a Short -Term Rental permit through Bayfield County Planning and
Zoning Department. Completed application can be mailed/emailed to the address/email above.
SECTION A: ESTABLISHMENT INFORMATION
Estab lime t Name
il� e Or 1 -LC
Establishment Tax ID #
1 `1
Town/City of
Dr�r,rnan
Establishmen Street Address
L{ $ �1 p Larson t
City
� S �
State
WE
Zip
79?P
____
SECTION B: OWNER INFORMATION
Property Owner
Sep. btinov&n
Email Address I
s JnovA ASS Fir
Phone Number
o (Sl)a &-5)
Owner Mailing Address
?6a', Erse A.
City
State
aj
Zip
SECTION C: IF OPERATING WITH PARTNER OR AGENT
Legal Licensee (partnership, I.LC, ill', or Inc.)
i n1e4ttic-
Em
II Address F
V -i S !
Phone Nu ber
(m)3 ' 5 -
Licensee Street Address
3 yr A-'.
City
Ci nnc4
State
OH
Zip
9c2O8
Agent Name (if applicable) J
v&n
Email Address
f 5&M
Phone Number
Sci-^
Agent Street Address
5c --Me
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
17
tat
3
_
2
3
vtructure
Type;
House H Du lex D Cabin C Yurt A artment A Condo CO Other O , lease describe
Heating Source:
Electric E Natural Gas (NG) Propane P Wood W Fuel F Other O please describe
Water Source:
Public/Municipal M Private Well(P)Public/Munici
Sanitary Source:
al M Private Onsite Wastewater S stem P
1111 JUL 0 1 ZUh D
Bayfield Co. Zoning Dept.
ttfs iS t
$:c4.5 .L # )
b / 3/ teas
$-' YFIELD
HeaL#ti' PerA%4*vtn1-
Healthy 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:
Tourist Rooming House Water Analysis
**Samples are ONLY accepted Monday -Thursday from 8am to 4pm**
• 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
Phone
Date Collected
Time Collected Circle One
AM
PM
Facility Address
city
Collectors Name
Biling/Mailing Address
City, State
Zip
Bacteria Sampling Point (Kitchen, bath sample tap, lake name, etc.)
Nitrate Sampling Point (Kitchen, bath, sample tap, etc.)
Reporting Method (check one)
0 Mail my results ❑ Call 0 E-mail
Well Type (check one)
❑ Drilled ❑ Jetted 0 Other
❑ Driven Point O Dug
Well Driller ID# (for new wells only)
Well Construction Date
Unique Well # (If known)
Reason for Sampling (check one)
❑ Routine Sample ❑ Investigative
❑ Other ❑ Real Estate Transaction
FOR LABORATORY USE ONLY
Sample ID # BAY
Bacteria Results (Total Coliform)
Safe Unsafe
❑ E. Coli Absent O E. Coli 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 #: 5T — OD 2°1FS
Tax ID: °jy
S -T -R: Z2^ —�1
Town: 'Druo�vv\.o,r.
What zoning district is the project located in?
R-1 ❑R-2 ❑R-3 ❑R-4 ❑R-RB U U U ❑A-1 ❑A-2 ❑F-1 ❑F-2 U ❑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 JNo
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€u .
Yes ❑ No
Does the project require sanitary?
SanitaryPermit #: v� j - '. S Public System:
# of bedrooms:
Yes O No
Does the project require an affidavit?'LLC ❑ Trust g 4k LLC
Affidavit #:
Number of Units: j
Number of Bedrooms:
Number of Bathrooms:
Number of Stories: I
❑ After -the -Fact (ATF)
ATF Fee Amount:
Inspected by:'N y
Date of Inspection: - a\
Inspection Notes:
23_O01
Re -Inspected by:
Date of Re -Inspection:
Denied by:
Date of Denial:
Reason for Denial:
Date Denial Letter Mailed:
Approved by: ; `
Date of Approval: 22— i
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.
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:
Town, City, Village, State or Federal
Permits May Also Be Required
Shoreland
LAND USE —X (previous 23-0199)
SANITARY - 21-169S
SPECIAL A -
SPECIAL B/CONDITIONAL —
BOA —
No. 26-0358 Tax ID: 13946
Issued To: BILLY THE BEAR LLC,
BAYFIELD COUNTY
PERMIT
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
Location: S22 - T44N - R07W
Town of DRUMMOND
Legal Description: N 333 1/3' OF S 833 1/3' OF GOVT LOT 2 IN V.1098 P.905 188C & 188F
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
work or land use has not begun.
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.
This permit may be void or revoked if any performance conditions are not
completed or if any prohibitory conditions are violated.
Desi Niewinski
Authorized Issuing Official
July 22, 2026
Date