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3124125,2:01 PIN Revize Online Forms <br /> Chicken/Duck Keeping License Application <br /> FDel] <br /> Submitted by: Ana Concepcion Rivera Parra <br /> Submitted On: 2025-03-24 13:54:48 <br /> Submission IP: 199.249.109.13 (172.31.71.138) <br /> proxy-IP (raw-IP) <br /> Status: Open <br /> Priority: Normal <br /> Assigned To: Barb Benesch <br /> Due Date: Open <br /> ANNUAL CHICKEN/DUCK—KEEPING <br /> LICENSE APPLICATION <br /> MO S V. <br /> 2401 Mounds View Slid. I Mounds View, MN 55112 <br /> (763) 717-4000 1 Fax (763) 717-4019 <br /> info@ m o u n d svi ewm n.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 /> M New Application $100 (Site Plan Required) 0 Chickens # of Chickens # of Ducks <br /> ❑ Renewal Application $30 ❑ Ducks 10 2 <br /> * Applicant First Name * Applicant Last Name k Email <br /> Ana Concepcion Rivera Parra <br /> Valid Email {required <br /> Street Address City State Zip Code <br /> 8478 long lake moundsview 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 /> Phone 1 Email <br /> Ex. (123) 456-7890 <br /> Valid Email Required <br /> PRIVACY NOTICE: I understand the information provided in this form may be considered private or confidential data. I further understand that I may not be required by law to provide <br /> such information.The purpose of providing such information is to aid the City in its determination on said application.I acknowledge that providing, or failing to provide,such <br /> information may affect the City`s determination on said application. I understand this information will be made available to the City of Mounds View,its City Council,agents and <br /> https-llmoundsviewmn_rje.revize_com/reports/777348 112 <br />