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3/10/25,9:56 AM Revize Online Forms <br /> Chicken/Duck Keeping License Application <br /> Print FDel] <br /> Submitted by: Miles Och <br /> Submitted On: 2025-03-08 13:00:43 <br /> Submission IP: 73.94.102.16 (172.31.21.217) <br /> proxy-IP (raw-IP) <br /> Status: Open <br /> Priority: Normal <br /> Assigned To: Barb Benesch <br /> Due Date: Open <br /> Attachments <br /> • CoopLocationPlans - 2665 Sherwood Rd.jpg_- 2025-03-08 01:00:44 pm <br /> ANNUAL CHICKEN/DUCK—KEEPING <br /> LICENSE APPLICATION <br /> MOMD14-S <br /> VIEW 2401 Mounds View Blvd. I Mounds View, MN 55112 <br /> (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 <br /> ordinances. All chicken & duck keeping licenses are valid from January 1 through December 31 of each year. The application fee will not be <br /> pro-rated and is non-refundable. <br /> New Application $100 (Site Plan Required) Chickens # of Chickens # of Ducks <br /> ❑ Renewal Application $30 ❑ Ducks 6 0 <br /> * Applicant First Name * Applicant Last Name * Email <br /> Miles Och <br /> Valid Email Required <br /> Street Address City State Zip Code <br /> 2665 Sherwood Road Mounds View MN 55112 <br /> Phone 1 Phone 2 <br /> Ex. (123) 456-7890 <br /> If the applicant is not the owner of the property, please complete the section below. <br /> Owner Name Street Address City State Zip <br /> https://moundsviewmn.rja.revize.com/reports/763462 1/3 <br />