Application for Permit to
House or Harbor Pigeons
TC-12 rev. 3/16
Donna Lent, Town Clerk
Lauren Thoden, Deputy Town Clerk
One Independence Hill, Farmingville, NY 11738
(631) 451-9101 FAX: 451-9264
1. DATE OF APPLICATION:
2. APPLICANT’S NAME: FIRST LAST
3. STREET ADDRESS: TOWN: STATE: ZIP:
4. ZONING DISTRICT: 5. TAX ITEM #: 6. TELEPHONE # DAY: 7. TELEPHONE # EVENING:
8. IF THIS IS A RENEWAL APPLICATION, STATE WHETHER OR NOT THERE HAS BEEN ANY CHANGE IN STRUCTURE,
I.E., ADDITIONS OR MOVING:
9. ADDRESS OF PREMISES WHERE PIGEONS ARE TO BE HOUSED OR HARBORED, IF DIFFERENT FROM #3 ABOVE:
STREET ADDRESS: TOWN: STATE: ZIP:
10. Has applicant been convicted of a violation
of the provisions of the pigeon ordinance? Yes No
Please note that the location, size and construction of lofts
must not violate other town ordinances such as zoning and
State Building Construction Code.
11. DIMENSIONS OF LOFT: 12. AREA OF LOFT: 13. HEIGHT OF LOFT:
Note: If the loft is 100 square foot or more in area, the applicant must obtain a building permit before commencing
construction. Building Permits are issued by the Building Department, 1 Independence Hill, Farmingville, NY 11738.
14. AREA OF PROPERTY:
Square Feet
15. MAXIMUM # OF PIGEONS
TO BE KEPT IN SAID LOFT:
16. Has the subject premises been used for the housing or
harboring of pigeons prior to the effective d
ate of the
ordinance (1/17/77)?
Yes No
Note: In event said loft has been used for the housing or harboring of pigeons prior to January 17, 1977, it may be
maintained as a nonconforming loft. However, if said use is discontinued, or if the loft is enlarged or rebuilt after being
substantially destroyed, said enlarged or renovated loft must meet all requirements of section 85-892 (D) (1) a-g.
17. Please note that this application must be accompanied by a survey or diagram showing the proposed location of said loft and
its distance from surrounding residences and lot lines. Said pigeon permit must be renewed annually. Fee: $35
Sworn to before me this ________ day of ______________
20_______
__________________________________________
NOTARY PUBLIC
18. SIGNATURE
FOR OFFICIAL USE ONLY
Approved Disapproved
By:
Expiration Date: Permit #: Receipt #:
