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2. 
3. City of Yachats
   441 Highway 101 N
   PO Box 345
   Yachats, OR 97498
4. Phone: 541-547-3565
   Fax: 541-547-3063
6. Property Street Address*
8. Applicant Name*
9. Applicant Phone*
11. Property Owner Name, if different from Applicant
13. Applicant Mailing Address
15. Required Documentation
    Please provide to the city:

    • Signatures from any neighbor(s) whose home(s) is/are within 100 feet of the coop/pen. Failure to obtain approval signatures will result in permit denial.
    • Certification that property is not covered by neighborhood conditions, covenants, and restrictions that prohibit the keeping of poultry.
    • Plot plan showing location of pen or structure (coop) and home. Plot must include distances from the property lines.
17. Optional: Attach documents here
19. The following conditions must be met for the keeping of chickens on property within the city limits:
    • Poultry must be kept in a clean and sanitary pen or structure, no part of which shall be located less than forty (40) feet from any residence other than the residence owned or occupied by the person owning or possessing the animals.
    • Pen or structure (coop) shall be well built and provide for the reasonable security of enclosed animals from predators. Permittee must agree to secure the permitted animals at night.
    • Permit will authorize keeping of up to 3 birds in total, none of which may be roosters.
    • Food for the permitted poultry will be stored in a secure area free of vermin and not accessible to bears, raccoons, or other scavengers. When poultry is secured for the night, all food containers will be secured.
    • Manure must be removed with sufficient frequency to prevent offensive odors. Any manure retained for fertilizer will be spread upon the ground evenly and turned under at once.
    • The City will inspect the property and coop prior to issuing a permit. An initial permit fee of $25 will be charged to cover inspection and processing costs to the City. If there are no complaints or known violations of the permit provisions, subsequent permits (if any) may be issued without cost.
    • Complaints received by the City relative to non-compliance with the provisions of the permit will be investigated and, if found valid, may result in cancellation of the permit.
21. By signing below, I acknowledge:
    • I have read and fully understand the conditions listed above. I have and will continue to meet all conditions.
    • I understand that the property is subject to an inspection before a permit is issued.
    • All the information provided in this application is accurate and true to the best of my knowledge.
23. Applicant Signature*
    Typed name is accepted as signature.
24. Date*
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26. 1. Receive an email copy of this form.
27. Email address

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