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°' ` TOWN OF YARMOUTH Bo�dof :
� Health
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451
'�"`� Telephone(508)398-2231,ext. 1241 Health
Fax(508) 760-3472 0;��,t:�_ ,.-, –�;--
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APPLICATION FOR OPERATION-2012 `�`�`�'� � ° �-'��°'-�
POULTRY HE T PT.
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PLEASE COMPLETE ALL QUESTIONS � ,�, �'":{: Y � � ` �-��I �r
NAME �Sr G(,..��-(!j�"'���� NOME TEL.NO. �� �jCjs ',� 7�
LOCATION ADDRESS I(n2- OlA M,da,� JQ�, S y �'Z.�o(�p� '
MAILING ADDRESS(IF DIFFERENT)
NUMBER OF FOWL NUMBER OF PENS/COOPS NUMBER OF ROOSTERS �
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMI5SION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER SIZE OF YARD/PEN AREA
(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?
�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.
Town of Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits.
Please check appropriately if paid: Yes No
,—__SIGNATURE .--- DATE
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THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: ✓POULTRY: 1-9 chickens $30.00
10 or more Chickens $40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE:$ O, DD ;
12/08l1 I