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s °� ` TOWN OF YARMOUTH Boardof
� � Health �
= 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02 -
�aE Tele hone 508 398-2231,ext. 1241 �����i�
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Fax(508) 760-3472 Lt�! �' � .���� '
"" Ft�AI-��H,DEPT. j
APPLICATION FOR OPERATION-2���4, � . � __
POULTRY � � ;;u.C��,�,;,. �b./
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PLEASE COMPLETE ALL QUESTIONS � ` �
E-MAIL
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NAME HOME TEL.NO. – —
LOCATION ADDRESS �� (n r� ��('l-r ��`� • . �l��1M.f�(r 1 PI
MAILING ADDRESS(IF DIFFERENT)
NUMBER OF FOWL 'T NUMBER OF PENS/COOPS NUMBER OF ROOS_TERS_ _� ___ ___�
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 I S �
� �/1�
�
(W OD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS � WATER TROUGHS I
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TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN
TYPE OF FACILITY USED FOR MANURE STORAGE I %r � ��
METHOD OF DISPOSAL OF MANURE �� 0\,F-Q �( HOW OFTEN�(��� '
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING?�' �''�( (� IC��� I �l��,� �1�n�
�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 taaces and liens must be id rior to renewal or iss ance o�ou�ermits__ —__--__ ___ -- __-_
Please check appropriately if paid: Yes No
SIGNATURE DATE
THE FULL POULTR OUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S OTAL.
FEES: '/POULTR . 1-9 chickens �30.00
10 or more Chickens 40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE: $ ,3 0.OO
10/14/IS