Keeping of Domestic Hens Permit Application
District of North Vancouver
Community Planning Department
355 West Queens Rd, North Vancouver, BC V7N 4N5
Questions about this form: Phone: 604-990-2480
Form submission: with permit fee to address above
The personal information collected on this form is done so pursuant to the Community Charter and/or the Local
Government Act and in accordance with the Freedom of Information and Protection of Privacy Act. The personal
information collected herein will be used only for the purpose of processing this application or request and for no other
purpose unless its release is authorized by its owner, the information is part of a record series commonly available to
the public, or is compelled by a Court or an agent duly authorized under another Act. Further information may be
obtained by speaking with The District of North Vancouver’s Manager of Administrative Services at 604-990-2207 or at
355 West Queens Road, North Vancouver. Revised: Sep 18, 2017 Page 1 of 2
PLETION: To ensure legibility, please complete online and then print. Sign the printed copy and
submit as indicated above. All sections of this application must be complete and permit fees paid upon
submittal or the application will be deemed incomplete.
For District Use Only Permit #
Applicant Information
Mailing Address
Postal Code
If the applicant is not the property owner, written authorization from the owner is
required here:
Owner’s Name
Owner’s Email Address
Owner’s signature to authorize Keeping of Domestic
Hens Permit Application Date
PLEASE NOTE: This permit is valid for one year from the date of issue and must be renewed
annually by paying the annual fee and passing the annual inspection. Hens must not be kept until
the initial inspection of the coop and run has passed.
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Keeping of Domestic Hens Permit Application Revised: Sep 18, 2017 Page 2 of 2
Site Sketch Plan: Provide a site plan of the lot layout. Show and label property lines, street(s), accessory
buildings, and distance to nearest residential dwellings. Provide the footprint dimension for all buildings.
Provide dimension and height of chicken coop.
Applicant certification Please submit signed copy to the District
I certify that this application and all information submitted as part of this application are true, complete,
and accurate to the best of my knowledge. I also acknowledge that I have reviewed Bylaw 8211 “A bylaw
to regulate the keeping of domestic hens” and other related Bylaws regarding this application. I also
agree to allow Staff or appointed agent(s) of the District to enter the subject property to make any
necessary inspections thereof.
Applicant Signature
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