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� r T (� VVN C� YARMOUTH Bo�of �
� Health '
1146 ROUTE 28, SOUTH YARINOUTH, MASSAGHUSETTS 02664-24451 �
�� Telephone(508)398-2231,ext. 1241 ������ ,
Fax(508)760-3472
DEC `� 4 2015
APPLICATION FOR OPERAT l�'�I"�:2 1� _ � � �
POULTRY � �� �� '� k,��� .�` HEALTH DEPT. �
�b �;I�- y . >`' � '
PLEASE COMPLETE ALL QUESTIONS
E-MAIL HEYSANDY@CAMPWK.COM
NAME SANDY RUBENSTEIN HOME TEL.NO. 5O8'�82-3798
LOCATION ADDRESS CAMP WINGATE*KIRKLAND
MAILING ADDRESS(IF DIFFERENT) ���E ROCK ROAD YARMOUTH PORT, MA 02675 I
NllMBER U�FOWL 1� NUMBER UF PENSICC)C)PS 1 NUMBER OF ROOSTERS O I
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION QF THE AEALTH DEPARTMENT.
TYPE QF SHELTER �NOOD SHED ' SIZE OF YARD/PEN AREA 2O' X ZO' '
twaan,coNcxErE,�rc.� �
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NtIMBER OF WATER OUTLETS 0 WATER TROUGHS 1 '
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TYPEOF STORAGE FAGILITY USED FOR F£ED/GRAIN TUPPERWARE TRUNK INSIDE PLASTIC BOX �
;
TYPE OF FACTLITY USED FOR MANURE STORAGE RUBBER COMPOSTER j
METHOD OF DISPOSAL OF MANURE COMPOST OR RUBBISH HOW OFTEN WEEKLY �
� 1f2 x 481NCH HARDWARE CLOTH �
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING. i
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X REl�tEWAL '
NfiW APPLICATI�N- IF NEW APPLICATION, PLEASE ATTACH A COPY OF PLOT PLAN SHOWING LOT i
LIN�S AND LOCATION OF STABLE, PEN, ETC.,AND ALL ENCLUSURES. ALSO,A �
WRITTEN LETTER OR STATEMENT,SIGNED BY ALI.ABUTTERS TO PROPERTY. �
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Town of Yannouth taxes and liens must be paid prior to renewal or issuance of your permits. !
Please check appropriately if paid: Yes No �
, IZ i � I5�
SIGNATURE �' DATE
THE FULL POULTI� COU T IS O EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: ✓� POU : 1-9 chickens $30.00
l0 or mare Chickens ��
ROOSTER (NOTE: SPEGIAL APPROVAL REQUIRED EOR ROOSTERS}
NO ROOSTBR
TOTAL DUE:� 4d•�O
10,'14115