HomeMy WebLinkAboutApplication ��(�-00 f�0�1�-cS�G��17�`��"� G3C�C�C��MCD .
°� ` TOWN OF YARMOUTH °t� ' � Zo�S
� � Board of
I���.�'H DEPT.
� � = 1146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664-24451 Health
'. '�o" Telephone(508)398-2231,ext. 1241 nivision
Fax(508)760-3472 �,�
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APPLICATION FOR OPERATION-2016 ;� ;� (p0.O� `
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAIL ,����� C' � /��
N,e,Mg `�'/,'` ` HOME TEL.NO. ��,`����79
STABLE ADDRESS � " cS�12��0 ,(��i( •+� � ��/f'` ���3
MAILING ADDRESS(IF DIFFERENT) S G%�/J'1^�f'
EMERGENCY CONTACT(NAME/PHONE#1 ��`� ���`` G� `-�'�3
� i A II l�T I��� • 6Y�►[�3�7�___'____ " _. '-______ - -..... __. -_- .
� -� � �TE?�s�rcci_i"r.��E��rj'—�-�---� — . 3�,_,
TOTAL NUMBER OF HORSES/PO1�lIES� TOTAL NUMBER OF STALLS�
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIMALS
WITHOUT PRIOR PERMISSION OF THE I3EALTH DEPARTMENT.
PLEASE LIST EACH HORSE/PONY/DONKEY/COW SEPARATELY:
ANIMAL NAME IF APPLICABLE
BREED
#YEARS OWNED
COLOR
SEX ''
DATE OF RABIES VACCINATION
DATE OF EEE VACCINATION '
DATE OF OTHER VACCINATIONS
TYPE OF STABLE/SHELTER /�G�T� SIZE OF CORRAL AREA
(WOOD,C CRETE,ETCJ
NUMBER OF HOSE BIB WATER OUTLETS s DRAINS WATER TROUGHS ar
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN ���
TYPE OF FACILITY USED FOR MANURE STORAGE �� '
METHOD OF MANURE DISPOSAL�G�'lr,G`,$'!'.r.x�� C'"!"''' FREQUENCY G.Ql� � l�'�`" '
_ ---- - _—__ __ _-- _ _ -- — ----__ --- � _ _ __ - — - ___ _____ _
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? `�%��� ,d' �p,__
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES �/ NO
(PLEAS NOTE: POULTR SWINE,SHEEP, CATTLE, GOATS REQUIRE SEPARATE LICENSURE.)
�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 'or to renewal or issuance of your pernuts.
Please check appropriat y i id: Ye No
SIGNATURE DATE ` v �/
FEES: STABL HORSE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ 60.op
IO/14/IS
L�ST L�c-�56'. (o tko25�, LPon1�