HomeMy WebLinkAboutApplicationT
i i
� , �-��--c���
� r TOWN OF YARMOUTH Boardof
� � Health
� = 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHLTSETTS 02664-24451 -
WITACNEE � ��
'�a Telephone(508)398-2231, ext. 1241 �;, , e�
Fax(508) 760-3472 in����.sU JI�L��vi�i n �
hOV 12 2013
APPLICATION FOR OPERATION-2014 HEq�;H. E �, r; ; �
POULTRY ; - ;{
� . ��""� ���
; PLEASE COMPLETE ALL OUESTIONS
E-MAIL
� NAME � � HOME TEL.NO.Cj1F�'�i���'I���
LOCATION ADDRESS �c � � �,.esi�'
MAILING ADDRESS(IF DIFFERENT) �
, _-NUlGIBEI��F rOWL � TfC7MBEK OF-PENS/�6O�S -- - Nt�1VI�ER OF R�OSTERS - --- —
� ----
�' PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
I
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
�' TYPE OF SHELTER I����� SIZE OF YARD/PEN AREA �L sZ �����
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS � WATER TROUGHS
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN
TYPE OF FACILITY USED FOR MANURE STORAGE �_
�
METHOD OF DISPOSAL OF MANURE HOW OFTEN �
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? ��c*�� �_�Sjy.,�-� ` �z�
�RENEWAL
NEW APPLICATION- IF NEW APPLICATION, PLEASE ATTACH A COPY OF PLOT PLAN SHOWING LOT
LINES AND LOCATION OF STABLE, PEN, ETC.,AND ALL ENCLOSURES. ALSO,A
WRITTEN LETTER OR STATEMENT,SIGNED BY ALL ABUTTERS TO PROPERTY.
r _ T�wri of�arma�th taxes-and tierrs�must t3e p$it�-prior t�renewa��r issuance-�€ycru�permits. _ _ ------ ----
� Please check appropriately if paid: Yes No
SIGNATURE �� � V�Q DATE ,� \ �
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: ✓ POULTRY: 1-9 chickens 3 Q
10 ar more Chickens 0.0(�T�
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE:$ �Q,CX:
10/0$/13
�t�"I�: :�-�c C�tt1 Ci�-��vS