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CITY OF CENTERVILLE BACKYARD CHICKEN PERMIT <br />Applicant Name: <br />Address: <br />PID#: <br />Lot dimensions: <br />(Must be a minimum of 10,000 square feet) <br />Phone: <br />Email: <br />PERMANENT PEN: Attach a diagram indicating pen dimensions and location, <br />including distance from adjoining structures and property lines. <br />MOVEABLE PEN: Size: <br />NUMBER OF HENS - LIMIT () <br />$75PERMIT FEE <br />I am the owner of theproperty listed above. I will at all times keep the chickens in <br />accordance with the City Code and understand failure to obey such conditions will <br />constitute a violation of the provisions of this ordinance and be grounds for cancellation <br />of the permit. If I will no longer be keeping chickens, any pen or coop must be removed <br />upon expiration of the permit or within of ceasing to use the pen or <br />coop,whichever is earlier and surrender my permit to the City. Premises subject to <br />privaterestrictions and/or covenants that prohibit the keeping of fowl shall void <br />any permit issued. <br />Thispermit may be revoked or suspendedfor violation of City Code, following <br />writtennotice and allowing applicant opportunity toappeal the revocation to the City Council. <br />Signature ofApplicant: ___________________________________Date: ____________ <br />********************FOR OFFICIAL USE ONLY******************************* <br />Permit Fee Paid: <br />Approved _______ Denied _________ <br />Check:Cash: <br /> <br />