February 2022
Chicken Permit Application: Adjacent Neighbor Consent Form
Applicant Name _______________________________________________________________
Permit Address________________________________________________________________
No permit shall be issued and no chickens shall be allowed to kept unless the owners of
all residentially-zoned adjacent properties consent, in writing, to the permit application.
(Roosters are prohibited.) For purposes of this permit, adjacent property means all
parcels of property that the applicant’s property comes into contact with at one or more
points. A chicken coop and/or chicken run shall not be closer than 25 feet from any
residential structure on any other premises and no closer than 10 feet from the property
line.
Instructions to Adjacent Property Owners
Your neighbor is applying for a permit to keep chickens on their residentially-zoned
property. A maximum of six chicken hens may be kept under this permit. If you are an
adjacent property owner, your consent is required for issuance.
By signing this form, you are providing written consent for the issuance of the permit.
Name_____________________________ Street Address_____________________________
Signature_________________________________________Date_______________________
Name_____________________________ Street Address_____________________________
Signature_________________________________________Date_______________________
Name_____________________________ Street Address_____________________________
Signature_________________________________________Date_______________________
Name_____________________________ Street Address_____________________________
Signature_________________________________________Date_______________________
