HomeMy WebLinkAboutApplication I �l� —UO �c�P—I S—(2��-01
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� � Y TOWN OF YARMOUTH Boardof
� � Health
= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-2 , - -,
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Telephone(508)398-2231, ext. 1241
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Fax(508)760-3472 Dt� � •, r ,J i�
APPLICATION FOR OPERATION-2016 ��' ' �T�"��PT,.
POULTRY �' C�" �(o(P p,�
PLEASE COMPLETE ALL QUESTIONS � `��'
E-MAIL �j�j1'1� �, u(,�� 6n, �I�/G��bl�
NAME � .Pi►/� HOME TEL.NO. `� ��- �,�j� �b�7�
LOCATION ADDRESS /\( � ��'
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MAILING ADDRESS F DIFFE NT)
_ __ iv`�fNI�ER Or — i 1��-�r��ii Si —ivuivlFsE�0��6t�ST�RS—_. _
PLEASE NOT • E DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT. `
TYPE OF SHELTER_�� ��D� ,��1����'NI'1) SIZE OF YARD/PEN AREA ��� Q�
�n/��OOD,COI�CRETE,ETC.)
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NUMBER OF WATER OUTLETS =,�' WATER TROUGHS ���
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN ✓Q,l�1 Z� �
TYPE OF FACILITY USED FOR MANURE STORAGE — �4--(�,C`�(� �1��(�j��/'1�
METHOD OF DISPOSAL OF MANURE �,(J�(V�(J p�y1,6 HOW OFTEN�Y�'�Y�W�/,�Y
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PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? 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.
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Please check appropriately if paid: Yes No
SIGNATURE DATE (�����.�j
THE FULL POULTRY COUNT IS NO O EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: ✓ POULTRY: 1-9 chickens
10 or more Chickens 40.0
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
✓ NO ROOSTER
TOTAL DUE: $__�{0 .O O
10/14/15 �,/ C�i� S �� � '
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