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' °� r TOWN OF YARMOUTH Boardof
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i � ♦ Health
= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHiJSETTS 02664-24451 -
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Telephone(508)398-2231, ext. 1241
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APPLICATION FOR OPERATION=�2�1C '''w`� � 5 2Q16
POULTRY ' � �
�� �� HEALTH DEPT.
PLEASE COMPLETE ALL E TI N � ��� `�`J��
QU S O S
E-MAIL-°,�;�7in�.r�2-T-v� l�.`�tc3�,�3�
NAME �s,,,,.�c�,� �Q�-n HOME TEL.NO.�7`IS �(�Z'l? `F�
LOCATION ADDRESS � ��, ����.,,1.,���c- � � � ���- C�ZL�� 7�
,
j MAILING ADDRESS(IF DIFFERENT)
-- _�CUl�$�R OEFQ.�I. I.� Ni MRFR OF�EI�LLC'(�C1P� � -- _ l�IIJMRFR QE_BQQSTERS._-- S
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� PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
' TYPE OF SHELTER ��,��Q SIZE OF YARD/PEN AREA �e � �`�`
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS 1 WATER TROUGHS �
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN 1 v�rz,r�-\
TYPE OF FACILITY USED FOR MANURE STORAGE Cf�vt.e�o,s�
,
METHOD OF DISPOSAL OF MANURE�'`�s s no�� HOW OFTEN
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? C� , ���,,. tiJ�resi.
I �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 Yannouth taxes and liens must be aid rior to renewal or issuance of our ermits.
_ _— ea e • c,c a prop ia eiy i'_-'f`pai�—__'Yes-_ P_�o_ Y P
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SIGNATURE �/�� ��---- (^Q��..--- DATE_� Z� 1�
i
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: ✓ POiJLTRY: 1-9 chickens $30.00
10 or more Chickens $40.00
i ✓ ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE: $ '-�� -O�
10/14/15
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