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Backyard Chicken Permit Application

2. 
4. BACKYARD CHICKEN PERMIT APPLICATION
6. Instructions
   Instructions for Backyard Chicken Program (PDF)

   Please read these instructions before proceeding.
7. I have read and agree to the instructions*

   1. I agree
9. Site Address
10. Parcel Pin #
12. Name of Applicant
13. Zoning and Current Use of Property
15. Phone Number
16. Email Address
18. Number of Hens to be kept
    Maximum of four (4) hens. No roosters are allowed.
20. I am aware that I must receive approval of the Village prior to obtaining hens and housing on the previously provided site address.*

    1. I agree
22. I will follow all Village ordinances and state laws relating to the care and keeping of animals.*

    1. I agree
24. I hereby grant the right to Village staff to enter onto my property to inspect the required coop and pen and/or to properly investigate any complaint received by the Village regarding the keeping of chickens.*

    1. I agree
26. I am aware that I am responsible for keeping hens within the confines of the required area on my property at all times.*

    1. I agree
28. I acknowledge that I live in a single-family detached dwelling as per zoning code.*

    1. I agree
30. I understand that this permit is a limited license for the purpose of keeping chickens and no vested zoning rights arise from the permit being issued. I also understand that the permit is non-transferrable should my property be sold or occupied by a person different that on this application. The license is valid for period of one year from the date of issuance.*

    1. I agree
32. I understand that any private restrictions on the use of the property shall remain enforceable and shall supersede any provisions of this license. I affirm that there are no private restrictions including, but not limited to, deed restrictions, neighborhood associations or bylaws, covenants and restrictions and rental agreements. A license issued to a person whose property is subject to private restrictions that prohibit keeping of hens is void.*

    1. I agree
34. As chicken coops (hen houses) are defined as “accessory structures” under Ordinance 1906, they must also adhere to the following requirements regarding accessory structures:
    A. When a side or rear yard are required, no coop may be located closer than ten (10) feet to the lot line or any other structure on the property. B. No accessory structure shall be constructed on any lot prior to the start of construction of the principal building to which it is accessory. C. Accessory structures on a property with a septic system will need health department approval prior to the issuance of a building permit. Coops must be located a minimum of ten (10) feet from the septic tank, septic lines and absorption field.

    A. When a side or rear yard are required, no coop may be located closer than ten (10) feet to the lot line or any other structure on the property. B. No accessory structure shall be constructed on any lot prior to the start of construction of the principal building to which it is accessory. C. Accessory structures on a property with a septic system will need health department approval prior to the issuance of a building permit. Coops must be located a minimum of ten (10) feet from the septic tank, septic lines and absorption field.
38. Please attach a current plat of survey showing the proposed location of the coop and pen. Please also describe the proposed hen coop and pen, including materials and size. Please include how improvements will be fenced per requirements.
40. Under Penalty of Intentional Misrepresentation or Perjury,
    Under Penalty of Intentional Misrepresentation or Perjury, I declare that I have examined and/or made this application and it is true and correct to the best of my knowledge and belief. I agree to construct said improvements in compliance with the provisions of all applicable ordinances. I realize that the information that I have affirmed for a basis for the issuance of the license herein applied for. Approval and construction of plans must be provided through the issuance of a separate building permit(s).

    Under Penalty of Intentional Misrepresentation or Perjury, I declare that I have examined and/or made this application and it is true and correct to the best of my knowledge and belief. I agree to construct said improvements in compliance with the provisions of all applicable ordinances. I realize that the information that I have affirmed for a basis for the issuance of the license herein applied for. Approval and construction of plans must be provided through the issuance of a separate building permit(s).
42. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
44. Electronic Signature
45. Date
    Date
47. Printed Name
48. Property Owner
52. Received by Staff
53. Title
54. Date
    Date
56. Approved by Staff
57. Title
58. Date
    Date
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60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit Submit and Print

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