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Chicken Coop License Application (For Egg Production Only)

  1. (If land trust, give trust number, trustee and list all beneficiaries on separate sheet)

  2. (If applicant is different than the landowner, applicant must have written landowner approval)

  3. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  4. SECTION BELOW TO BE COMPLETED BY CITY STAFF

  5. Coop Dimensions (4 ft. sq. required per chicken):

  6. Run Dimension (8 ft. sq. required per chicken):

  7. Maximum number of chickens allowed (not to exceed six chickens):

  8. THIS PERMIT IS ISSUED SOLELY FOR THE USE INDICATED, AT THE LOCATION SPECIFIED, ON THE DATE ISSUED.

  9. Once your application has been approved by the City, you will receive a secure link from the City of Carbondale in which to pay your application fee.

  10. Please choose how you would prefer to receive the secure link.*

  11. Your permit will be emailed to you once your payment has processed.

  12. Chicken Coop License Approved By:

  13. Fees: $25 per chicken coop license; $10 for renewal; $25 per transfer

  14. Leave This Blank:

  15. This field is not part of the form submission.