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Application for Animal Permit

  1. Type of Permit

  2. Permit (Check All That Apply)

  3. Animals Kept At

  4. If animals are rented, please provide the name.

  5. Electronic Signature*

    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.

  6. Agreement

    I hereby agree to abide by the laws and the rules and regulations of the Division of Animal Services. I certify that all statements made on or in connections with the application are true and complete to the best of my knowledge and belief, and I understand and agree that any violation of Iowa City ordinances pertaining to animals, Iowa State Code Sections 717A or 717B, or Iowa City Animal Services rules and regulations relating to permits may be cause for denial or revocation of permit.

    I further understand and agree that my premises may be inspected in accordance with Section 8-4-2, City Code and such other sections as may be applicable.

  7. Division of Animal Services Report & Recommendation

  8. Meets Requirements

    Applicant(s) meets, requirements set forth in the City Code and Iowa City Animal Services rules and regulations, and I therefore recommend this Permit.

  9. Does Not Meet Requirements

    Applicant(s) does not meet, requirements set forth in the City Code and Iowa City Animal Services rules and regulations, and I therefore recommend this Permit:

  10. Leave This Blank:

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