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� � . °� ` TOWN OF YARMOUTH � Bo�-dof �
� � Health
= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451 -
°*�A'O Telephone(508)398-2231,ext. 1241 �Va't p
Fax(508)760-3472
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APPLICATION FOR OPERATION- 2013
; POULTRY ��'� �AN Z L ��,"v
� F�����i�' 4:r������ �s.�Y., f f�,w�45..'�4 , �Wr '��a .
' PLEASE COMPLETE ALL QUESTIONS �'�� �`"� '� �
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NAME � HOME TEL.NO. 3����
LOCATION ADDRESS � �-- � � � - �
MAILING ADDRESS(IF DIFFERENT)
- -- _ .__ _ _. ___ _ _ - -- _—
— -_ ______
-- _ ___
NUMBER OF FOWL �;-- NUMBER OF PENS/COOPS � NUMBER OF ROOSTERS c�
� PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
} WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER t,J O O C SIZE OF YARD/PEN AREA �.
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS � WATER TROUGHS �
TYPE OF STORAGE FACILITY USED FQR FEED/GRAIN ���� ���
TYPE OF FACILITY USED FOR MANURE STORAGE ---� - `� " -
METHOD OF DISPOSAL OF MANURE HOW OFTEN , > -
� PEN AREA ENCLOSED BY WHAT TYPE O FENCING? C����- �Y��
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�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 PROP�RTY.
____ _ --- �_ _ —__ _ ____ ;
�_ _ __ -- - - ---_ --- ,
Town of Yannouth taxes and liens must be paid prior to renewal or issuance of your permits.
Please check appropriately if paid: Yes�� No
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SIGNATURE��OtC¢— � �Q �•�.e,5 DATE C
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR' TO AL. �
;
FEES: �[POULTRY: 1-9 chickens $30.00
10 or more Chickens $40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
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TOTAL DUE:$ �� .Q p j
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11/0l/12
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