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1 CITY OF ALBANY HEN LICENSE APPLICATION INSTRUCTIONS: The issuance of Hen Licenses are subject to the rules as written in §115-31through 35 of the Code of the City of Albany. All applications must be submitted to the City Clerk, City Hall, Room 202 by the owner or primary occupant of the dwelling. Exclusive of the building s located on the property, it must have two- hundred (200) square feet of total lot area for the keeping of two hens, with an additional one-hundred (100) square feet for every additional hen up to the maximum of six hens permitted. The twenty-five ($25.00) dollar fee is non-negotiable, non-refundable, and must accompany your application. Please complete every section of the application for prompt process. This application does not license the keeping of any rooster (male chickens). By submitting this application you are attesting that chickens will be kept in a clean, covered, and well-ventilated enclosure (coop). APPLICANT INFORMATION: Applicant Name: Phone Number: Address: (Street) (City) (Zip Code) PROPERTY OWNER INFORMATION IF DIFFERENT (only complete this section if property owner and applicant are different): Proporty Owner Name: Number: Address: (Street) (City) (Zip Code) LOCATION OF SUBJECT PROPERTY: Address: (Street) (City) (Zip Code) ---PAGE BREAK--- 2 Please describe the coop/cage that the hen(s) will be kept in (using the space provided below): Written Description Sketch (Please use the space below to provide a sketch, indicating the proposed location of coop): ---PAGE BREAK--- 3 HEN / COOP/ CAGE(S) DESCRIPTION: How many hens do you intend to keep on the above property? Does the property location comply with the required square footage of total lot area? YES NO This application may require additional information if certain conditions are met. Please check which conditions apply and attach supporting documentation. YES NO The applicant is not the property owner but the notarized signed statement for the property owner is attached granting permission for applicant/tenant to keep hens. YES NO The coop is to be located less than 25-feet from the occupied residential dwelling located on adjacent properties and attached is the adjoining property owner’s statement of support. YES NO The coop structure exceeded 80 square feet and the permit or other documentation from the Director of the Department of Buildings and Regulatory Compliance approving the structure is attached. (Applicant Signature) (Date)