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°� r TOWN OF YARMOUTH Boardof
� � Health
= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451 -
M�� E E
"°�*�r° Telephone(508)398-2231, ext. 1241 Q������
Fax(508)760-3472
,JAV 2 0 2016
APPLICATION FOR OPERATION�� , � HEALTH DEPT
POULTRY ���"^ L.
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PLEASE COMPLETE ALL QUESTIONS "
E-MAIL�Q'�S 5�1��C�{�1!��).C�
NAME � HOME TEL.NO.f��c�'3��
LOCATION ADDRESS
MAILING ADDRESS(IF DIFFERENT)
- ___NIIMBBRQE_EQ�i.��=.�TUMBE�QF P��iS/�9rJP�_=�,._,�.:__1�IUMBFR 4F_RC�Q�'�E�S .�_
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER���'� SIZE OF YARD/PEN AREA �,�{� �(Q�� _ �
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS `� WATER TROUGHS '�
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN l 1 C� efJ� �
TYPE OF FACILITY USED FOR MANURE STORAGE�S��C �� �`
METHOD OF DISPOSAL OF MANURE i ( HOW OF'�EN 1.�
,c.S v � -�r—
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? �(j
�
S
�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 nrior to renewal or issuance of vour p_e_rmits.
Please check appropriately if paid: Yes No — ----
SIGNATURE DATE , �S �
� _ � �
�
THE FULL POULTR C NT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: � POULTRY: 1-9 chickens $30.00
10 or more Chickens $40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE:$ 30.Gn
10/14/15