Backyard Chicken Permit Application

Backyard Chicken Permit Application

For additional information and regulations, please go to the Town of Galena 2020 Zoning Ordinance found at https://ecode360.com/GA3097/documents/Legislation#category-495718017-year-2020. For specifics to Backyard Chicken requirements, please visit https://ecode360.com/documents/GA3097/public/753204642.pdf.
Property Owner Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Rental Property?
Property Information
Zoning District
Site Address
Parcel Number
Subdivision
Lot/Unit
Lot Size (in acres)
Side Yard Setback
Rear Yard Setback
Is the property located in the Galena Historic District? If yes, a copy of the Maryland Historical Trust approval letter needs to be submitted.
Coop & Run Information
Estimated Cost of Construction
Coop Width
Coop Length
Coop Height
Coop Square Footage
Run Width
Run Length
Run Height
Run Square Footage
Is there an existing fence enclosing the rear yard?
Fence Type
Fence Height
Animal Information
Number of Chickens
Breed(s) of Chickens
Please describe the routine maintenance plan of the coop/run
Please describe the egg collection routine
Please describe the food & water plan
Please describe the waste disposal plan
Please describe the bedding/mulch plan
Please describe how neighbor complaints will be addressed
Additional Information
24-Hour Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
PLEASE SUBMIT THE FOLLOWING DOCUMENTATION:
- Site Plans: Submit one (1) electronic copy of a site plan showing property lines, existing structures, proposed coop/run location, setbacks and neighboring dwellings if applicable.
- Photos: Please submit photos of proposed structure and the proposed site.
- Neighbor Approval: Please submit letter(s) from all adjoining property owners of signed approval. Written consent from 75% of owners of residentially/commercially zoned adjacent properties within 200 feet of the proposed coop/run must be obtained.
File Upload

Cancelof
Additional Information/Questions
By signing and submitting this application, the applicant affirms that they are authorized to submit this permit application on behalf of the property owner, business, or entity identified herein, and certifies that all information, statements, and materials provided in connection with this application are true, accurate, and complete to the best of their knowledge and belief. The applicant understands that any false, misleading, or incomplete information may result in denial, suspension, or revocation of the permit and may subject the applicant to any applicable penalties under Town ordinances or other applicable law.

I ACKNOWLEDGE THAT:
- I must obtain zoning approval before construction begins.
- Chickens must remain confined to my property.
- The coop/run must remain clean and predator-resistant.
- Chickens must receive food and water daily.
- Manure must be properly managed.
- The Town may conduct inspections.
- Permit violations may result in revocation.
- Any dimensional changes require reapplication.
- I must comply with Maryland Poultry Registration requirements.
- Backyard Chicken Licenses must be renewed annually.
No work can begin until you receive an approved permit. NO EXCEPTIONS.
Signature
Date

MonthDayYear
Date
Should be Empty:

Backyard Chicken Permit Application

Property Information

Coop & Run Information

Animal Information

Additional Information