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� � r� TOWN OF YARMOUTH Boardof
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1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451 . e `��i�J��
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Fax(508) 760-3472 ����D��D
APPLICATION FOR OPERATION-2016 _ �t� + 0 �015
POULTRY HEALTH DEPT.
PLEASE COMPLETE ALL OUESTIONS
E-MAIL
; NAME���pft% ��f�('p�yG/ HOME TEL.NO. �f" ��� �'�S'/7
LOCATIONADDRESS�����gc�i�vs' �' U(,�/C'r6� �. l�� yt�iG�rlar�lY�i �/i,¢- Qa-�o ?�
MAILING ADDRESS(IF DIFFERENT)
NUMBER OF FOWL_ � NUMBER OF PENS/COnPS_ 3 NSTMB�R OF RO�STEI�,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
(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 t�es and liens must be paid prior to renewal or issuance of your permits.
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SIGNATURE C�e"li. � �.,�r��--- DATE l0��3��/3�
,
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�OO
10/14/15