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3/12/2021 <br />Revize Online Forms <br />Mourns I V! <br />ANNUAL <br />CHICKEN & DUCK KEEPING LICENSE APPLICATION <br />2401 Mounds View Blvd. I Mounds View, MN 55112 <br />EW(763) 717-4000 1 Fax (763) 717-4019 <br />info@moundsviewmn.org <br />Valid from January 1 — December 31 <br />Requirements relating to the keeping of chickens and ducks is located in Mounds View City Code Chapter 701.06. All permit holders are <br />required to be familiar with the provisions of this chapter. In submitting a license application, the applicant declares that they meet the <br />requirements for issue of said permit, and that such location will be operated in compliance with the adopted regulations and ordinances. All <br />chicken & duck keeping licenses are valid from January 1 through December 31 of each year. The application fee will not be pro -rated and is <br />non-refundable. <br />New Application $100 (Site Plan Required) <br />Chickens <br /># of Chickens <br /># of Ducks <br />❑ <br />Renewal Application $30 <br />❑ <br />Ducks <br />3-6 <br />0 <br />* Applicant First Name <br />Amber <br />Street Address <br />5406 Adams Street <br />City State <br />Mounds View Minnesota <br />* Email <br />amber@grantjohnson.com <br />Valid Email Required <br />Phone 1 <br />16128599082 <br />Zip Code <br />55112-1411 <br />Phone 2 <br />Ex. (123) 456-7890 <br />* Applicant Last Name <br />Urlacher <br />If the applicant is not the owner of the property, please complete the section below: <br />Owner Name <br />Street Address <br />City <br />State <br />Zip Code <br />Email <br />https://moundsviewmn.rja.revize.com/reports/119932 1/3 <br />