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2. Approved?

   1. Yes
   2. No
3. Approval Signature
4. Date:
6. Name (Last, First, M.I.)*
8. Address*
10. City*
11. State*
12. Zip*
14. Home Phone*
15. Cell Phone
17. Email*
18. Do you own your residence?*

    1. Yes

    1. No
20. Have you taken a chicken husbandry course?*

    1. Yes
    2. No
21. If yes, please provide certificate.
23. Please provide an overall view of your property with indication on where you plan to have the chicken coop located.*
27. Read and initial each item, then sign and date below.
29. If required to do so, I have provided written permission from the property owner of the residential lot on which I will be keeping chickens.*
    (First-time applicants only. See Fredericksburg City Code § 14-231.)
31. I understand and agree to abide by all of the conditions under which I will be allowed to keep chickens, which are as follows:*
    1. 1. No more than four chickens shall be kept on any residential lot.
    2. 2. No person shall keep any rooster.
    3. 3. This permit does not allow a holder to sell eggs or slaughter chickens.
    4. 4. The chickens shall be provided with a clean, covered, well-ventilated enclosure that is secure from predators.
    5. 5. The chickens must be kept in the covered enclosure or within a fenced area at all times.
    6. 6. No enclosure shall be located closer than twenty feet to a side yard line and five feet to a rear lot line.
    7. 7. No enclosure shall be located closer than twenty five feet to any occupied residential structure.
33. I understand that the City may revoke my permit for a violation of any law or regulation governing chicken keeping.*
35. Applicant Signature: I understand that checking the box below is the equivalent of signing my name.*

    1. I Accept
37. Applicant Name*
38. Date*
    Date
40. Permits must be renewed by January 1 each year. Failure to do so will cause you to incur late fees and/or be cited by Animal Control/Police Officers for failure to obtain a permit.
42. PERMIT EXPIRES: December 31,
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit Submit and Print

* indicates a required field