CITY OF CORALVILLE URBAN CHICKEN PERMIT APPLICATION
Transcript of CITY OF CORALVILLE URBAN CHICKEN PERMIT APPLICATION
CITY OF CORALVILLE
URBAN CHICKEN PERMIT APPLICATION
Failure to complete all sections of the application and provide supporting documentation will result in a denial of your application.
APPLICANT INFORMATION [PLEASE PRINT]
Name: __________________________________________________________________________________________________________
Address: ________________________________________________________________________________________________________
Home or Cell Phone: _____________________________________________________________________________________________
**24-hour emergency contact phone number: _____________________________________________________________________ This is the number that will be called if we receive a complaint about the chickens on your property.
INITIAL EACH ITEM
______1) I have read the Coralville Urban Chicken Ordinance and understand the requirements for keeping chickens.
______2) I am aware that I am responsible for keeping chickens within the confines of my property at all times.
______3) I am aware that I must receive approval from the City prior to obtaining chickens.
______4) I will follow all City ordinances and state laws relating to the care and keeping of animals.
______5) I acknowledge that I live in a single family dwelling located on a lot zoned for residential use.
______6) I understand that the permit is a limited license for activity and no vested zoning rights arise from the permit being
issued and that the permit does not run with the property.
______7) I understand that any private restrictions on the use of the property shall remain enforceable and shall supersede
the permit.
______8) I grant the right for City staff to inspect my property prior to approval of this permit and at any time to investigate
a complaint.
______9) I have successfully completed the required urban chicken training and attached a copy of the certificate.
______10) I acknowledge that all chickens must be banded in accordance with procedures established by the City.
______11) I understand only hens are allowed and not more than six (6) licensed chickens are permitted per property.
______12) I understand this permit is only valid for a period of one calendar year and shall expire December 31st of each year.
______13) I understand that all chickens shall be secured in a coop from dusk to dawn.
______14) I understand City ordinance requires certain construction materials and minimum requirements for the coop
enclosure.
I affirm that all statements contained in the application are true and correct and that I the permit holder will keep the chickens in compli-
ance with all related ordinances and Urban Chicken Policy. I understand that failure to comply with regulations may result in revocation
of the permit and/or issuance of a municipal infraction.
Signature: _________________________________________________________ Date: ________________________________________
*A tenant shall attach to this application written permission from the landlord to keep chickens on the property. Own Rent*
Mail forms with supporting documents AND payment to: Coralville Police Department| PO Box 5911| Coralville, IA 52241. Check or money order only. Make payable to Coralville Police Department.
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CITY OF CORALVILLE
URBAN CHICKEN PERMIT APPLICATION
Describe the chicken coop and pen including the materials used and total cubic feet.
Sketch a diagram below of the property including the dimensions and:
• Identify the adjacent properties by street address
• Indicate the location of coop and pen
CHICKEN COOP DESCRIPTION & MATERIALS
CHICKEN COOP LOCATION & PROPERTY INFROMATION
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URBAN CHICKEN PERMIT APPLICATION
CITY OF CORALVILLE
Failure to complete all sections of the application and provide supporting documentation will result in a denial of your application. LANDLORD APPROVAL FORM —FOR TENANTS ONLY
TO BE COMPLETED ONLY IF THE APPLICANT IS A TENANT.
I am the owner/landlord of __________________________________________, Coralville, Iowa, AND I give permission for my tenant,
____________________________________________________________, to install a chicken coop and keep chickens on the property.
——————————————————— Owner/Landlord [Printed]
_____________________________________________________ ___________________________
Signature of Owner/Landlord Date
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Permit Application Fee: $25 Paid ________
City Permit Approval: Date:______________ Official:_____________________________
City Inspection: Date:______________ Official:_____________________________
Meets Requirements: Yes _______ No _______ Corrections Needed _______
Reason (s) for Denial: __________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
1st Band Number _________________________ $5.00
2nd Band Number ________________________ $5.00
3rd Band Number ________________________ $5.00
4th Band Number ________________________ $5.00
5th Band Number ________________________ $5.00
6th Band Number ________________________ $5.00
Total: ________
Notes: _________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
CITY OF CORALVILLE
URBAN CHICKEN PERMIT APPLICATION
FOR CITY STAFF USE ONLY
PERMIT APPROVAL FORM
CHICKEN ID LEG BANDS
PERMIT NUMBER: ______________________________________
ISSUE DATE: ___________________________________ EXPIRATION DATE: December 31, 20____
ISSUED BY: ______________________________________
Subscribed and sworn before me by________________________________ At Coralville Iowa on _____________
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