HomeMy WebLinkAboutApplication ��� —Ol /����P-f5-�2os-o ►
°� r� TOWN OF YARMOUTH Boardof
� ♦ Health
III --- = 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451 -
�� Health
Telephone(508)398-2231, ext. 1241
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Fax(508)760-3472 Q�C�Gab�D
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APPLICATION FOR OPE�A��p ' 20�� `. M �t115
� POULTRY� � . �� , '�
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PLEASE COMPLETE ALL QUESTIONS �
�M'" ��� . ,...HEqLTH pEPT
E-MAIL �cu,,., be�l'121 � �or,�,�+.,,�+
NAME �Jt�rJ� Q�t) f'�(i5�� �pMn�'jQ.�I HOMETEL.NO. SO�-3q� " � 63I
LOCATION ADDRESS �Z � �✓�$� �C.�iha,��� �o� We�l- l�,���t h �� p z 6 7 3
MAILING ADDRESS(IF DIFFERENT)
1�TGIVIB�,R 0�'��L NTJNIBEiC�FPENS -- ---NUIGi�ER�F 1�OOSTER�_ O .__—�_ _ - ,
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR P RMISSION OF THE HEALTI�DEPARTMENT.
TYPE OF SHELTER � SIZE OF YARD/PEN AREA I �� �'� ' v �{
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS � WATER TROUGHS �
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN ��� �'1 Q�.(�c�q�
TYPE OF FACILITY USED FOR MANURE STORAGE .TlGtg V� C�;,/�
METHOD OF DISPOSAL OF MANURE V � HOW FTEN ��t.� Q w��u.
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING� u u��-� w�� `�C��
V 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 ✓
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SIGNATURE �%%� �" DATE /�/ �� �J
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: '�POULTRY: 1-9 chickens 30:0
10 or more Chickens
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
✓ NO ROOSTER
TOTAL DUE: $ .30.00
10/14/15