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5/16/23, 2:27 PM <br />Revize Online Forms <br />Chicken/Duck Keeping License Application <br />Submitted by: Sarah Curtis <br />Submitted On: 2023-05-16 14:24:04 <br />Submission IP: (65.156.151.154) <br />proxy-IP (raw-IP) <br />Status: Open <br />Attachments <br />• Site Plan.pdf - 2023-05-16 02:24:05 pm <br />Print <br />ANNUAL <br />CHICKEN/DUCK-KEEPING LICENSE APPLICATION <br />2401 Mounds View Blvd. I Mounds View, MN 55112 <br />M 0 NDS VI E-W (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 90.005. 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 />❑ Renewal Application $30 <br />* Applicant First Name <br />Sarah <br />Street Address <br />7660 SPRING LAKE RD <br />Phone 1 <br />715-577-2197 <br />* Applicant Last Name <br />Curtis <br />® Chickens # of Chickens <br />❑ Ducks 6 <br />* Email <br />City <br />Mounds View <br />Phone 2 <br />sarahmcurtis15@gmail.com <br />Valid Email Required <br />State <br />MN <br />Ex. (123) 456-7890 <br />If the applicant is not the owner of the property, please complete the section below: <br /># of Ducks <br />Zip Code <br />55112 <br />https://moundsviewmn.rja.revize.com/reports/334628 1 /3 <br />