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TOWN OF YARMOUTH ���a�lu�� �
= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-2445
�l �'� Telephone(508)398-2231,ext. 1241 H�T�I DEPT.
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Faa�(508)760-3472 r, ' '
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APPLICATION FOR OPERATION-2016 �
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STABLE �
PLEASE COMPLETE ALL OUESTIONS E-MAIL
NAME ��:��PL�;, � �LGI/ HOME TEL.NO. �7'L/-$��:�5.`�S
STABLE ADDRESS�!��j'1"'j���'�/��"l� ,� �i��l�l d1fT� I
MAILING ADDRESS(IF DIFFERENT) �is�t�
EMERGENCY CONTACT(NAME/PHONE#1 c5,r9��2 f �
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VETERINARIAN(NAME/PHONE#) �.�/ ,t _,,tl,�'� �D�-��j�-�,�.a
TOTAL NUMBER OF HORSES/POrTIES / TOTAL NUMBER OF STALLS i j
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PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIMALS ;
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT. i
PLEASE LIST EACH HORSE/PONY/DONKEY/COW SEPARATELY:
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ArTIMAL NAME IF APPLICABLE ��� '
BREED � �
#YEARS OWNED •� �
COLOR zvYt TF �
SEX 4
DATE OF RABIES VACCINATION !
DATE OF EEE VACCINATION t�
DATE OF OTHER VACCINATIONS i/
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TYPE OF STABLE/SHELTER SIZE OF CORRAL AREA I o o�c/,ro
OD ONCRET ETC.) �
NUMBER OF HOSE BIB WATER O E DRAINS WATER TROUGHS �, ;
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN /G'G,¢E�'r� �
TYPE OF FACILITY USED FOR MANURE STORAGE ,F�c�" F'ND C0�2L ;
��FE'� ... . --�.�^QT�?tiT�Y—'4L.��� -------�
CORR.AL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? LdDOD �
;
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO_ •�
(PLEASE NOTE: POULTRY,SWINE,SHEEP, CATTLE, GOATS REQUIRE SEPARATE LICENSURE.) ';
t/ RENEWAL �
NEW APPLICATION- IF NEW APPLICATION,PLEASE ATTACIi A COPY OF PLOT PLAN SHOWING LOT I,
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 r to renewal or issuance of your permits. '
Please check appropriatel if�yi�: Yes�No �
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SIGNATURE '�'' DATE ID
FEES: ST � -&-1-HO�SE 8. ( $�:��additional horse/animal) TOTAL DUE:S 30.00
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