M-8 - Draft of Urban Chicken Application

CITY OF TIFFIN URBAN CHICKEN PERMIT APPLICATION Mail forms with supporting documents AND payment to: City of Tiffin / PO Box 259 / Tiffin, IA 52340 Check or money order only. Make payable to City of Tiffin. 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: Work Phone: ** 24-hour emergency contact phone number: Own Rent* *A tenant shall attach to this application written permission from the landlord to keep chickens on the property. Number of chickens to be kept _____. No roosters are allowed, maximum number of hens (4) Complete the following attachments: • Attachment A: Description of the chicken coop and pen, including materials used and cubic feet. • Attachment B: Sketch identifying the property boundaries and indicating the location of coop and pen. • Attachment C: For tenants only - Landlord Approval form. • Attachment D: Urban Chicken Adjacent Owner form. Initial: ____ 1) I have read the Tiffin Urban Chicken Policy and understand the requirements for keeping chickens. ____ 2) I am aware that owners of all adjacent properties (i.e., all properties that contact each other at any point) must give their written consent for any urban chicken permit application to be approved. ____ 3) I am aware that I first 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 am aware that I am responsible for keeping chickens within the confines of my property at all times. ____ 6) I am aware that I may not make any dimensional changes to my chicken coop without first obtaining approval from the City of Tiffin. ____ 7) I grant the right for City staff to inspect my property prior to approval of this permit. I further grant the right for City staff to inspect my property one year after the permit Is granted and at any other time to investigate a complaint. ____ 8) I acknowledge that I live in a single-family dwelling per zoning code. ____ 9) I affirm that I have never been found guilty of any animals welfare, neglect or cruelty code. ____ 10) I am aware that I may not add to the number of chickens listed on this application without first obtaining approval from the City of Tiffin. ____ 11) I understand that the permit is a limited license for the activity and no vested zoning rights arise from the permit being issued and that the permit does not run with the land. ____ 12) I understand the private restrictions on the use of the property shall remain enforceable and shall supersede the permit. I affirm that there are no private restrictions including, but not limited to, deed restrictions, condominium restrictions, neighborhood association bylaws, covenants, and restrictions and rental agreements. A permit issued to a person whose property is subject to private restrictions that prohibit keeping of chickens is void. ____ 13) I understand that only hens are allowed and not more than four (4) licensed chickens are permitted per property. ____ 14) I understand this permit is only valid for a period of one calendar year and shall expire December 31st of each year. ____ 15) I understand that all chickens shall be secured in a coop from dusk to dawn. ____ 16) 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 compliance 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