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Home My WebLink About26-0556Return to: County UseOnly: 117E 511 Street, PO Box 58 Bayfield County Planning and Zoning Department Submission #' Washburn, WI 54891 LAND USE PERMIT APPLICATION Permit it: ' permitsCa'bavfieldcountv.wi.aov Date: la/la �o≥- Property Owner Name: Authorized Agent Name (if applicable): The DBLI<Trust Hill Construction LLC REC-IVED Telephone Number: Telephone Number: 612-618-9242 715-834-6750 E -Mail Address: E -Mail Address: OCT 01 2UZ6 vangor@comcastnet cante@hillconsWction.net Mailing Address: Mailing Address: Planning and Zoning Agency 14237 Staples St NE 15088 US Highway 63 City, State, Zip: City, State, Zip: Ham Lake, MN 55304 Hayward, WI 54843 Contractor: I Telephone Number: I E -Mail Address: \0 a 3 HUI Construction LLC 715-634-6750 Iieremvralhillconstructlon.net 14130 Warner Rd, Mason, WI 54856 Legal Description (if additional space is needed attach a separate sheet): Lot 2 of CSM 2345 In VoI13 CSM P311; Loc In SW SW in Doc 2024R-604310 Section, Township, Range: S29, T46N, R07W Town of: Delta Tax ID #: 39318 Lot Size (Acres/Square Feet): 7s8 eaes Project Use is: El Residential ❑ Commercial 0 Municipal If Commercial, estimated cost of construction: $ Project Type is: ID New Construction ❑ Addition/Alteration (existing structure) ❑ Change Use (existing structure) ❑ Relocate (existing structure) 0 RV Placement 21+ days ❑ Sign 0 Establishing a Business 0 Temporary (12 or less months) ❑ Shoreland Grading, Class A 0 RV Placement 4+ months, Class A ❑ Other (describe): Structure Type is: ❑ Residence 0 Principal Structure (describe): l7 Accessory Structure (describe): 0 Shoreland Exempt Structure (describe): ❑ Mobile Home (provide manufactured 50 x 100 Shop date): ❑ Shipping Container 0 Other (describe): Foundation Type: ❑ Basement 0 Walkout Basement El Slab ❑ Crawlspace 0 Ground 0 Skids 0 Other (explain): Proposed Structure (Provide Sq Ft based on outside dimensions, including unfinished areas, attached garages/above grade decks/arches): Basement Sq Ft: 1" Floor Sq Ft: Loft Sq Ft: 2e°Floor Sq Ft: 3M Floor Sq Ft: Garage Sq Ft: Porch Sq Ft: Deck Sq Ft: Other Sq Ft (describe): Other Sq Ft (describe): 5160 Total Sq Ft: 5160 Overall Height (finished grade to peak): 20' # of Stories: 1 I Existing # of Bedrooms on property: 4 Proposed # of Bedrooms in project: nie Sign is: R V is: ❑ New 0 Replacement ❑ New 0 Replacement ❑ On -premise 0 Off -premise ❑ 1 -sided ❑ 2 -sided Year yin #: ❑ On -building 0 Multi -Tenant Length: Width: Height: Make: Model: Application Page 1 o ate°Plaq ch x site Erl�ui:0 .� c.' '. Agee- -- i „t" a t -Fa �ifi1l:q ati"s fe uiredto. _ +� Show location of: ❑ Driveways ❑ Frontage Roads (include name) O Existing Structures ❑ Well (W) ❑ Septic Tank (SI) ❑ Drain Field (DF) ❑ Holding Tank (W1) ❑ Privy ) ❑ Lake ❑ River ❑Streanr/Creek OPond ❑Flood lain ❑W.etlands 0Slopes over 20% N Jcc ft flit GWfED RECEIVED OCT 012026 Bayfield Co. Planning and Zoning Agency Setback or distance from furthest extent of structure County Use Only. including eaves and overhangs to (include on site plan): Verifiedsetbneke - - - - Road Centerline 290 ft ft; Notea/Comn ents: Front Lot Line/Right-of-Way 660 ft. ftJ Side Lot Line 1 95 ft. - U a. (North &b South West, circle one) Side Lot ine 2 120 ft ft. (NorthEastSouth(Wcirc1e one) .: Rear Lot Line 280 ft ft. Septic/Holding Tank 235 ft $, Drainfield ft ft. Privy ft. ft. Well 250 ft. ' ft Existing StructureiBuilding ft. ft Wetland ft. ft. Elevation of Floodplain ft. ft. Ordinary High -Water Mark (OHWM) 280 ft. Other (describe) ft ft. Application Page 2 Baytield County, WI Zi Z• Z i o Z f/' / Z Z Lt; 1 V 12o' HE UBLK TRUST ny m a m a 100 39318 6 Om ! '1 i,r 02 ryryj r= 1— t 5/1212025,1:57:05 PM Rivers Survey Maps Lakes 0 Recorded Map Meander Lines Building Footprint 2000-2015 Approximate Parcel Boundary Existing Section Lines New Municipal Boundary Driveways All Roads ' Buildings Town Baytield 141 57 RD w RECEIVED OCT 012026 Bayfield Co. Planning and Zoning Agency 1:1,566 0 0.01 0.03 0.08 ml j-i--i-r-I l 7� 0 0.02 0.04 0.08 km Baytield County Lend Records Depadment http/1maps.bayIldcouolywIc,jov!RayeeidWABI ❑ Yes O No Has the location of the proposed project" been staked? If no, what date will this be completed: Note: The site will not be inspected nor permit issued until after the staking date listed above, ❑ Yes El 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. ❑ Yes El 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. El Yes O Is there an existing sanitary system on the property? If yes, what kind? Drainfield ❑ Holdin Tank ❑ Munici al/Public ❑ Other (describe): ❑ Yes N 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 ❑ Munici al/Public ❑ Other (describe): ❑ Yes ' No1 Will sleeping occur in the structure? If yes, contact local Uniform Dwelling Code (UDC) for approval and inspection requirements. Is the roje associated with any of the following: ❑ Rem e O Class A Special Use ❑ Class B Special Use ❑ Conditional Use O Variance Fee payment will be made via: ❑ Check (attached) O Cash (attached) El debit/credit/echeck (department to call once payment is ready to be taken) How would you like to receive yourpermit card? - 1 ❑ Mailto: OR O Email to: CA r n c {�'(oK r vc �n , n ❑ Property Owner Address O Agent Address O Contractor Address ❑ Other (provide name and email or address): `Include eaves, overhangs, sanitary system, and well in staking measurements All Land Use Permits expire Two (2) Years from the date of issuance if construction or use has not `EtUEMrmit 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. OCT 07 2026 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. tio��gk o one - and two-family dwellings may require review and approval by the UDC authority. All municip ees a requu o*enl rce 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 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. Owners) or Authorized Agent Printed Name: CoMctuCrnw lic Owner(s) or Authorized Agent Signature: Date:2 j NOTES: 1. 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. Owners, agents, & contractors must all be aware of permit details & conditions and permit card must be posted on property prior to start of project. Application Page 3 Bayfield County Impervious Surface Calculations These calculations are REQUIRED per WI Admin Code NR 115.05(1)(e) and Section 13-1-32(c) 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. The calculations are also REQUIRED in the case of a land division where the lot to be created or reconfigured will be reduced in lot area. 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): The DBLK Trust Mailing Address: Property Address: 14237 Staples St NE, Ham Lake, MN 55304 14130 Warner Rd, Mason, WI 54856 Legal Description: Section, Township, Range SW 1/4, SW 1/4, Sec 29 Township 46 N, Range 97 W in Doc 2024R-804310 Authorized Agent/Contractor Gov't Lot Lot # CSM# Vol & Page Hill Construction LLC 2 2345 13, P311 Lot(s) # Block(s) # Subdivision Town of: Delta ECEWFD Parcel ID # (PIN #) Tax ID # Date: 04- 016-2-46-07-29-3 03-000-12000 39318 10/1/26 OCT 012026 Bayfield co. Planning and Zonin .A cy Impervious Surface: An area that releases as runoff all or a majority of the precipitation that falls on it. lmper9ioiWs surface" excludes frozen soil but includes rooftops, sidewalks, driveways, parking lots and streets unless specifically designed, constructed and maintained to be pervious. Impervious surface standards shall apply to the construction, reconstruction, expansion, replacement or relocation of any impervious surface that is or will be located within 300 feet of the ordinary high water mark of any navigable waterway on any riparian lot or parcel and any nonriparian lot or parcel that is located entirely within 300 feet of the ordinary high-water mark of any navigable waterway. Calculation of Impervious Surface: Percentage of impervious surface shall be calculated by dividing the surface area of the existing and proposed impervious surfaces on the lot or parcel by the total surface area of that lot or parcel and multiplying by 100. If an outlot lies between the ordinary high-water mark and the developable lot or parcel described in subd. 1. and both are in common ownership, the lot or parcel and the outlot shall be considered one lot or parcel for the purposes of calculating the percentage of impervious surfaces. 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 or land division approved 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(c) and Section 13-1-40(h), the property owner may do any of the following: a. Maintenance and repair all impervious surfaces: b. Replace existing impervious surfaces with similar surfaces within the existing building footprint; c. Relocate or modify 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 13-1-22. Impervious Surface Item Dimension Area (Square Footage) Existing House 105 x 25 plus 38 x 40 5800 sf (includes porch roofs) Existing Accessory Building/Garage Existing Sidewalk(s), Patio(s) 65 x 25 (approx) 1133 sf Existing Covered Porch(s), & Deck(s) Existing Driveway 14 x400 5600 sf Other Structures Proposed Addition/House Proposed Accessory Building/Garage 50 x 100 plus 8 x 20 5160 sf Proposed Sidewalk(s) & Patio(s) Proposed Covered Porch(s) & Deck(s) RECEIvED Proposed Driveway OCT U 72026 Ba Proposed Other Structures nning and Zoning Agency Total: 17693 a. Total square footage of lot: 17693 b. Total impervious surface area: c. Percentage of impervious surface area: 100 x (b)/a = 5.36 If the proposed impervious surface area is greater than 15% mitigation is required. Total square footage of additional impervious surface allowed: @ 15% 49527 @ 30% 99055 (County Use Only) Date of Inspection: ./ Inspection Record: Zoning District ( ) Condition(s): Stormwater Management Plan Required: ❑ Yes ❑ No Signature of Inspector: Date of Approval;,A u/forms/impervioussurface Created: May 2012 (®Sept 2016, Sept 2020, Feb 2026) Proofed by: Letter of Authorization Bayfield 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 owner/s. If multiple property owners, each property owner must submit this signed letter. I, b sI4 Ekso\a St v Tr property owner), authorize 1A:\` Cer...?V b& o (authorized agent) to submit a (Example: land use, special use, conditional use, rezone/map amendment, appeal, variance, text amendment, etc.) for the following described project (Example: construction of residence or other structure, short-term rental or other use change, etc.) application on my behalf for the following described property: f —d\ 2 orr CSty.. &Z3WZN Yf,S Crm Pii Legal description of property:�'O L c °J S' J 5VJ CD aLK TRJfT) ¢d Oat. g P subject _oa4 &^ 6043(o Address of subject property: J$ ISO Waawvat- &A toter SYiht!o s/as/ai' Dated RECEIVED OCT 012026 Bayfield Co. Planning and Zoning Agency ROME .IN. MINE MEE MEN .EE ..E ..E w ■m■ mom a. l�� ... MORE WINE MINE MEM MINE .M.... mom loom Raj iii iii IN; ■om mop f',I III11 tRECENED OCT o 7 2026 Sa>fieb Cd. Planning and Zoning Agency m z z J a iI s s DNTE: 10/6/2026 SG E: SHEET: rc I I 0 z z J 1st Floor DNTE: 10/6/3036 SCALE: 'SHEET: I I I yl I I I I I6 I I I I �1 II I I I I IF I I sns�na RECEIVED OCT 072026 "' 1 BayfieI Ca. Planning :�:.� Z,r l,r..;.Agr.Fey T� I 1 ej I I I I lie I� I I I r-1 if'l F rr, II Ia:_L-I m ALL L MLRETEYWI5 SRfloTIwHI6SO cMsDNVYOO uAR MMSS RA&E •r•w 254 ExeR6rwunxwu+6x y S MLrN5ARE INUO¢VIWLL i( E C t D x NSN ANDS flDR FRONT SARA 6E DOOR SISAL vuEGp PWn56 IEex6lxER*tD - AND LOMINWUeRADAR STORM SMELTER rOLLS A OCT 0 7 2026 p ILA WL ER I ALL Fleo0. ORVNZA.. PIT ND.rrse veernxvw» _ coNtsEcn 1ENNnx PMKNLONLRERVWU CortAI4AROONNANELLER �" a W MlM TMee1OP Nraer FOufARRFLOORreRnR Planning and Zoning Agency � �° � I W4 NId OIRMUO ASS UNDER FLOOR _'� -'-', E5OSNS SAN/SR FLOOR IS Y LwlK I wm FOAM lxzuunOS uxcex jJ ' I' ROxioF6I.us NV n FOAM oNrN6 FRO6r VNDER 6AS.EWALL AND I' I IY LOSS OPAix IN EACH MY MOON FROST 5M ID IONS DRMN IN IKN RAY Ixw Mxox xF. OF FxOsrwu R Nnxu I. '.I Y6mx e.weDmIevic.LOxcrteiI - F6RAnreN:' IGGNeO6e SF nil 5HOP :!Efl N I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 1 I I T I I I I I I I I I --------- I I I I ______ I I I I I ________� ____-___ I I I I ------------------- / 1tlb' Itlb' DATE: 110/6/2026 Foundation SCALE: :.=SHEET: '*s mwxT PAxS 4 O Oo rwS wxcan o.[isrw.re ••_ 1'x16MLxiWMNLOMEx rx ....,... 7 "'MP PIT Storm Shelter Gross Section E.v.aan. xAmy Shop Elevation Elevation of plt, shop and storm shelter RECEIVED OCT 0 7 2026 ...,. Bayfield Co. d Planning and Zoning Agency ALL INT. FINISH __ AND INSULATION ARE .._u...:,,. - DONE BY OTHERS II E:+[xvw ruu V PAST '•'.._'•••• ••••••` exeeacD wrwcrzicroeuwur DOOR .....,. wx�rer[''" zoislzozs Y,N GL: SHEEr: Gross Section E'%MwxGxttE [0011x0 `Y r vr :: t • naT Y " Cross 5ectlon 4 RECEIVE® OCT 0 7 2026 Bayfield Co. z ,.. Planning and Zoning Agency a Gross 5ectlon 1 ss E 1 CWMCY�CO g EH Gross Section II vwwv�omms SHEET: Cross 5ecdon 3 OCT 07 2026 s_ 6ayfieki Co. i Planning and Zoning Agency m Gross 5ecdon 5 AFFIDAVIT OF AUTHORITY (Trust) PURPOSE. This Affidavit of Authority is used to certify the individual submitting an application is authorized when the property is owned by a Trust. ' STATE OF WISCONSIN ) ss. BAYFIELD COUNTY The undersigned affirms and states as follows: RECEIVED OCT 0 5 2026 Bayfield Co. Planning and Zoning Agency 1. Address of Subject Property: 14130 Warner Rd, Mason, WI 54856 2. The Subject Property is owned by: The DBLK Trust (Name of Trust) 3. The name(s) of the current Trustee(s): David Asplund Brenda 4. 1 certify that the Trust named in paragraph 2 is valid and in effect on the date signed below. I am the duly appointed agent of the Trust named above in paragraph 2, and I have the authority under the terms of said authorization to submit an application to 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 Trust to apply for and bind the Trust to the terms and conditions of any decision or permit that may be issued 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. Dated: Print Name Subscribed and SW rn to before me this L.nG day of 20_ Notary bli County, Wisconsin My commission: (31 PROCESSING INFORMATION INITIAL PROCESSING. Once the department receives your affidavit, the department will review it for completeness. If the information is not complete, the department may reject your affidavit and the application. REQUEST FOR MORE INFORMATION. The department may request that you provide more information or evidence to support your affidavit. DECISION. The department will review all documents submitted as part of the application for registration and title, this form included, and may approve, deny or request more information. RECEIVED OCT 052026 Bayfield Co. Planning and Zoning Agency Tracy Pooler From: Carrie Bender <carrie@hillconstruction.net> Sent: Tuesday, October 6, 2026 5:10 PM To: Tracy Pooler Subject: Re: Asplund Land Use Permit Attachments: LUP - Garage - page 3.pdf Hi Tracy, Now we should all be on the same pag , no sep ' o indoor plumbin n the shop, only the house. Thank you, Carrie From: Tracy Pooler <tracy.pooler@bayfieldcounty.wi.gov> Sent: Tuesday, October 6, 2026 2:12 PM To: carrie@hillconstruction.net <carrie@hillconstruction.net> Subject: FW: Asplund Land Use Permit Carrie, See Page 3 of Land Use Application submitted. ? Please review the application and modify as to the true nature of the project. Tracy Pooler - AZA Planning and Zoning Department 117 E 5th Street, PO Box 58 Washburn, WI 54891 Phone: 715-373-3512 Fax: 715-373-0114 Email: tracy.pooler(o)bayfieldcounty wi gov ]Z -'-'FIELD Fraudulent Billing Alert: Be aware that individuals submitting applications to our department have received scam emails. Bayfield County will NOT ask applicants to wire any funds. Please contact our office at zQning(abayfieldcounty wi.govv or 715 373-6138 with any questions or concerns. From: Carrie Bender <carrie@hillconstruction.net> Sent: Tuesday, October 6, 2026 11:23 AM To: Tracy Pooler<tracy.pooler@bayfieldcounty.wi.gov> Cc: David Asplund <vangor@comcast.net> Subject: Asplund Land Use Permit Hi Tracy, This garage is not going to be a commercial garage, it is for personal use only. There will be no indoor plumbing so there was no in en ion o addingaseptic septic or holding tank. I noticed a water sleeve notation from an earlier draft. I have attached the adjusted plan. The trench drains are for snow and water run off from toys so water isn't pooling on the concrete floor. Please let me know if you have additional questions or need further documentation. Thank you, Carrie Bender Hill Construction, LLC 715-638-0849 Bayfield County, WI 8:28 AM Novus-Wisconsin Access rev. 12.0206 ' a1 Estate Bayfield County Property Listing Property Status: Current Today's Date: 10/5/2026 Created On: 6/28/2024 3:40:47 PM Z Description Updated: 9/13/2024 Tax ID: 39318 PIN: 04-016-2-46-07-29-3 03-000-12000 Legacy PIN: Map ID: Municipality: (016) TOWN OF DELTA STR: $29 T46N R07W Description: LOT 2 OF CSM 2345 IN V13 CSM P311 LOC IN SW SW (DBLK TRUST) IN DOC 2024R-604310 Recorded Acres: 7.580 Calculated Acres: 7.580 Lottery Claims: 0 First Dollar: Yes Zoning: (R-1) Residential -1 ESN: 110 I Tax Districts Updated: 6/28/2024 1 STATE 04 COUNTY 016 TOWN OF DELTA 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE d Recorded Documents Updated: 1/9/2024 0 WARRANTY DEED Date Recorded: 8/12/2024 2024R-604310 0 CERTIFIED SURVEY MAP Date Recorded: 5/24/2024 2024R-603352 13-311 0 WARRANTY DEED Date Recorded: 2/5/2024 2024R-602109 0 QUIT CLAIM DEED Date Recorded: 1/8/2024 2024R-601805 O QUIT CLAIM DEED Date Recorded: 4/30/2019 2019R-577236 0 LAND CONTRACT Date Recorded: 2/13/2006 2006R-505021 938-245 Ownership Updated: 9/13/2024 THE DBLK TRUST HAM LAKE MN Billing Address: Mailing Address: THE DBLK TRUST THE DBLK TRUST 14237 STAPLES ST NE 14237 STAPLES ST NE HAM LAKE MN 55304 HAM LAKE MN 55304 P Site Address * indicates Private Road 14130 WARNER RD ® Property Assessment MASON 54856 Updated: 3/25/2026 2026 Assessment Detail Code Acres Land Imp. G1 -RESIDENTIAL 7.580 108,900 142,500 2 -Year Comparison 2025 2026 Change Land: 108,900 108,900 0.0% Improved: 26,500 142,500 437.7% Total: 135,400 251,400 85.7% Property History Parent Properties Tax ID 04-016-2-46-07-29-3 03-000-10000 13092 HISTORY 0 Expand All History White=Current Parcels Pink=Retired Parcels 0 Tax ID: 13092 Pin: 04-016-2-46-07-29-3 03-000-10000 Leg. Pin: 016106008000 39318 This Parcel t Parents 3 Children https://novus.bayreldcounty.wi.gov/access/master.asp?paprpid=39318 1/1 Land Use Permit Application Review Checklist Submission #: ,A Wha zoning district is the project located in? 1 ❑R-2 ❑R-3 ❑R-4 DR-RB ❑C ❑1 ❑M ❑A-1 ❑A-2 ❑F-1 ❑F-2 ❑W DM -M ❑ Yes o Is lot substandard (does not meet current zoning dimensional requirements)? Deed of record: ,aSes ❑ 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)? es ❑ No Is impervious surface required? (Required if riparian lot OR lot is entirely within 300 feet of OHWM of navigable waterway) ❑ Yes o Is the project located in the Floodplain? Zone: ❑ Yes p'No Are there wetlands on the property? ❑ Yes J -No Is project associated with a nonconforming use or structure? ❑ Yes giNo Is project associated with a variance? Case #: ❑ Yes fa'No is project associated with a Special B or Conditional Use Permit? Permit #: ❑ Yes J21 o Is the project associated with a Special A Use Permit? ❑ Yes _21'o Does the project require sanitary? 0 Existing ❑ New ❑ Intercept 0 Reconnect 0 Non -Plumbing 0 Public Sanitary Permit #: # of Bedrooms: ❑ Yes No Does the project require mitigation? Implementation Deadline: Date of Compliance: ❑ Yes J2 -No Does the project require an affidavit? Affidavit #: ❑ Yes ❑ No Did licensed surveyor mark lot line(s), if project is within 10 feet of required setback? ❑ Yes 0 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?,2lIew Construction ❑ Addition/Alteration ❑ Change Use ❑ Relocate ❑ RV Placement ❑ Sign 0 Establishing a Business ❑ Temporary 0 Shoreland Grading 0 Other, describe: Structure Type is: 0 Residence 0 Principal Structure Accessory Structure ❑ Boathouse (one story only) ❑ Open-sided/Screened Structure (gazebo, etc.) ❑ Stairway to navigable waters ❑ Mobile Home ❑ Shipping Container 0 Other, 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 sq ft (minimum $125) $ 'IQ Non -Habitable Residential Principal and Accessory Structures YY $0.20 x 7/sq ft (minimum $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 0 Land Use Revisions ❑ Special Use Permit - Class A 0 Floodplain Shoreland - Impervious Surface 0 Shoreland - Non -Conforming, etc. 0 Tower Siting/Collocation 1 ❑ Tower Coll cation 2 0 Metallic Mine 0 After -the -Fact (ATF) $ Inspected by: Date of Inspection: Re -Inspected by: Date of Re -Inspection: Denied by: Date of Denial: Reason for Denial: Date Denial Letter Mailed• Approved by: Date of Approval: Condition(s): ❑ Must meet and maintain setbacks from furthest extension of structure including eaves and overhangs. For personal storage only. ❑ For personal residence only. t for human habitation or sleeping purposes. ,Cwn/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. 1ZiUniform Dwelling Code (UDC) Permit from the locally contracted UDC Inspection Agency must be obtained prior to the start of construction (if applicable). ❑ 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. io 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 be removed by ONomust 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 B^YFIELD 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: THE DBLK TRUST LU-02584 14237 STAPLES ST NE HAM LAKE, MN 55304 Transaction Number: LU-02584-57605 Description Amount Shoreland - Impervious Surface $25.00 Non -Habitable Residential Principal and Accessory $1,032.00 Structures - $0.20/square foot (minimum $75) Payment Amount: $1,058.25 Reference: 7828667495 Paid by: Carrie Bender Payment Type: Other Transaction Date: 10/12/2026 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 I Impervious Surface — Yes Floodplain — No / Wetlands — No Mitigation — No / 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. 26-0556 Tax ID: 39318 Issued To: THE DBLK TRUST Location: S29 - T46N - R07W Town of Delta Legal Description: LOT 2 OF CSM 2345 IN V13 CSM P311 LOC IN SW SW (DBLK TRUST) IN DOC 2024R-604310 Residential Structure in R-1 zoning district For: New Construction [1 - Story ], Accessory Structure on a Slab [5160 Total sq. ft. ] Height of 20' (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 Tracy Pooler 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. October 12, 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): For personal storage 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 (if applicable). To be constructed per plan. No sewer and pressurized water allowed in the structure.