HomeMy WebLinkAboutApplication� �I6-603 Bo�-P�l� zo�( --o !
� _s � r T �-� � _O:� Y A-�A�Q U T H Board of
� � —,_�Iealth
' x _ ---- _
, ��E 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHLJSETTS 02664-24451 Health
; Telephone(508)398-2231,ext. 1241
l�ivicinn
{ Fax(508)760-3472 Q���D
� JA,'V 2Q20�6
� APPLICATION FOR OPERAT�41t+F-�,,2(�� �� � ; �°�Y�,
POULTRY R�j��� � F�EALTH DEPT
PLEASE COMPLETE ALL UESTIONS `�"J�' �Y• `1
E-MAIL `i�S S�, h a-q o p I�h(a �yn0.r� ,COYtj
NAME ����� �7,( � �� HOME TEL.NO. 77'�- �3 C) -07�1 0� �`,I
�
{ LOCATION ADDRESS �5 �..0 �,A y ar rn�,��,t� PJ Y� � J�/�/� C�2 ro �$�
,
MAILING ADDRESS(IF DIFFERENT)
1 - NUMBE__R OF FOW_L _�''�'_--- _` -_I�T[J1V�BER_.OF PE�iS/COOPS -- l -- - 1�MBE�t OF ROOSTERS �
� _
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
� WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT. _
� TYPE OF SHELTER ���d SIZE OF YARD/PEN AREA �U S$��
� (WOOD,CONCRETE,ETC.)
i
NUMBER OF WATER OUTLETS /F� WATER TROUGHS �
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN ���'-�� '�v ►-- � '`-^
TYPE OF FACILITY USED FOR MANURE STORAGE f\vY�-�-
� METHOD OF DISPOSAL OF MANURE Q�� ��J`` ^ HOW OFTEN 1 � r"���
' PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? � ��C k-t+� I•�"�
�
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.
, —.__SQ13�11�f Y3ifT14ll�1�3X�S 3Y1(1 I1Pd1S1TlllSt be p11C�.}1IIQY tn rPnawal nr ice�ian�g p�vniir�.�3�
--- _ _ -- ---- -
; Please check appropriately if paid: Yes No
_
;
SIGNATURE DATE , �'`� ��b
,•
THE FULL POULTRY� UNT IS OT 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: $ 30.Oo
ionans