Fillable Application For Beekeeping Permit Renewal (City of Hudson)

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Application For Beekeeping Permit Renewal (City of Hudson)

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BROWSE CITY OF HUDSON (WI) FORMS

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12/2018
Application for:
HONEY BEEKEEPING PERMIT RENEWAL
(As per Municipal Code §99-23)
505 Third Street ● Hudson, WI 54016 ● (715)386-4776 www.ci.hudson.wi.us
Date
Applicant Name
Mailing Address
Phone
Email
Property Owner Signature
(if different than applicant)
Site Address
(street)
(other information)
Number and location of hives on the property
The following are to be included with the application:
• Application renewal fee (nonrefundable) of $20.00 payable to the City of Hudson
• A brief narrative specifying any changes from the original beekeeping application, if applicable.
• Neighbor Notification Form
I hereby acknowledge that this information is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Hudson; that I understand this is not a
permit, but only an application for a permit. This permit will be valid for 12 months from the date of
issuance. Permit holder will be responsible for obtaining a renewal beekeeping permit before either the
expiry date of this permit or the renewal deadline of April 1
st
of the following year, whichever comes
first.
NOTE: If application is being filed after April 1
st
, the permit will go into effect the following year.
_________________________________
Applicant’s Printed Name Applicant’s Signature
OFFICE USE ONLY
Approved / Denied by:
Date
Application #
Receipt #
Expiration Date
(number)
CLEAR
PRINT
click to sign
signature
click to edit
NEIGHBOR NOTIFICATION FORM (BEEKEEPING PERMIT)
In accordance with the City of Hudson Municipal Code Chapter 99-23, I acknowledge that I have
been notified of my neighbor’s intent to have bee hive(s) at their home.
Date Information Provided:
Address for Potential Bee Hives: _
Beekeeping Applicant: ___________________________________________________________
__________________________________________________
_______________________________________________________
⃝ Approve - Allow beekeeper to place hives up to a 20 ft proximity of my property.
Phone: Address:
Date: Name: _____________________________________________ _____________________
____________________________________________ ____________________
⃝ Approve - Allow beekeeper to place hives less than 20 ft from my property.
⃝ Object - Reason?:
⃝ Household has resident with honeybee allergy (must provide medical documentation)
_________
_________
__________________________________________________________
________________________________________________________________________
________________________________________________________________________
SIGNATURE: ___________________________________________________________________
⃝ Approve - Allow beekeeper to place hives up to a 20 ft proximity of my property.
Phone: Address:
Date: Name: _____________________________________________ _____________________
____________________________________________ ____________________
⃝ Approve - Allow beekeeper to place hives less than 20 ft from my property.
⃝ Object - Reason?:
⃝ Household has resident with honeybee allergy (must provide medical documentation)
_________
_________
__________________________________________________________
________________________________________________________________________
________________________________________________________________________
SIGNATURE: ___________________________________________________________________
⃝ Approve - Allow beekeeper to place hives up to a 20 ft proximity of my property.
Phone: Address:
Date: Name: _____________________________________________ _____________________
____________________________________________ ____________________
⃝ Approve - Allow beekeeper to place hives less than 20 ft from my property.
⃝ Object - Reason?:
⃝ Household has resident with honeybee allergy (must provide medical documentation)
_________
_________
__________________________________________________________
________________________________________________________________________
________________________________________________________________________
ANY OBJECTIONS FOR PERMIT APPROVAL WILL BE BROUGHT TO PLAN COMMISSION AND COMMON COUNCIL FOR CONSIDERATION.
SIGNATURE: ___________________________________________________________________
⃝ Approve - Allow beekeeper to place hives up to a 20 ft proximity of my property.
Phone: Address:
Date: Name: _____________________________________________ _____________________
____________________________________________ ____________________
⃝ Approve - Allow beekeeper to place hives less than 20 ft from my property.
⃝ Household has resident with honeybee allergy (must provide medical documentation)
_________
_________
⃝ Object - Reason?: __________________________________________________________
________________________________________________________________________
________________________________________________________________________
SIGNATURE: ___________________________________________________________________
⃝ Approve - Allow beekeeper to place hives up to a 20 ft proximity of my property.
Phone: Address:
Date: Name: _____________________________________________ _____________________
____________________________________________ ____________________
⃝ Approve - Allow beekeeper to place hives less than 20 ft from my property.
⃝ Household has resident with honeybee allergy (must provide medical documentation)
_________
_________
⃝ Object - Reason?: __________________________________________________________
________________________________________________________________________
________________________________________________________________________
SIGNATURE: ___________________________________________________________________
⃝ Approve - Allow beekeeper to place hives up to a 20 ft proximity of my property.
Phone: Address:
Date: Name: _____________________________________________ _____________________
____________________________________________ ____________________
⃝ Approve - Allow beekeeper to place hives less than 20 ft from my property.
⃝ Household has resident with honeybee allergy (must provide medical documentation)
_________
_________
⃝ Object - Reason?: __________________________________________________________
________________________________________________________________________
________________________________________________________________________
SIGNATURE: ___________________________________________________________________
⃝ Approve - Allow beekeeper to place hives up to a 20 ft proximity of my property.
Phone: Address:
Date: Name: _____________________________________________ _____________________
____________________________________________ ____________________
⃝ Approve - Allow beekeeper to place hives less than 20 ft from my property.
⃝ Household has resident with honeybee allergy (must provide medical documentation)
_________
_________
⃝ Object - Reason?: __________________________________________________________
________________________________________________________________________
________________________________________________________________________
SIGNATURE: ___________________________________________________________________
(if more signatures are required, please print multiple pages)
ANY OBJECTIONS FOR PERMIT APPROVAL WILL BE BROUGHT TO PLAN COMMISSION AND COMMON COUNCIL FOR CONSIDERATION.
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Application For Beekeeping Permit Renewal (City of Hudson)

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Completed 15 July 2020

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