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3/4126. 10:36 AM <br />Revize online Forms <br />Chicken/Duck Keeping License Application <br />Del <br />Submitted by: Jeremy Maniak <br />Submitted On: 2025-03-04 01:00:17 <br />Submission IP: 66.41.156.230 (172.31.71.108) <br />proxy-IP (raw-IP) <br />Status: Open <br />Priority: Normal <br />Assigned To: Barb Benesch <br />Due Date: Open <br />Attachments <br />• image jpg_- 2025-03-04 01:00:18 am <br />ANNUAL CHICKEN/DUCK-KEEPING <br />LICENSE APPLICATION <br />MOUNDS V <br />IEW 2401 Mounds View Blvd. I Mounds View, MN 55112 <br />(763) 717-4000 j Fax (763) 717-4019 <br />info@moundsviewnin.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) <br />❑ Renewal Application $30 <br />* Applicant First Name <br />Jeremy <br />Street Address <br />5085 Greenwood Dr <br />Phone 'I <br />Ex. (123) 456-7890 <br />* Applicant Last Name <br />Maniak <br />❑ Chickens # of Chickens # of Ducks <br />❑ Ducks 5 0 <br />* Email <br />Valjd Email Required <br />City State Zip Code <br />Saint Paul MN 55112 <br />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 <br />Street Address <br />5085 Greenwood Dr <br />City State Zip <br />Mounds View MN 55112 <br />hUps-llmoundsviewmn_rja, revize_comIre ports1758509 113 <br />