HomeMy WebLinkAboutApplication �
�l�-Oo"?�b�-P_ I S-(u z-0�
� °� r TOWN OF YARMOUTH Boazdof
� � - Health
= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHLJSETTS 02664-24451 '
�� Telephone(508)398-2231, ext. 1241 Q���r���n
Fax(508)760-3472
IJ kC: `� a 2(115 ���
APPLICATION FOR OPERATION-2016 HEALTH DEPT.
POULTRY i
PLEASE COMPLETE ALL QUESTIONS '
E-MAIL rvtC�n�u��c��� Co M���'n�� '�
NAME�Q�.1�b Y�- ��� �a-�►tn HOME TEL.NO.�v8- 3�� - ��{�I
LOCATION ADDRESS ( 08 �t'o�-c.1 �,f'av� (�CP t �l. (ila-�I�IDu"��� M��} ��-���
MAILING ADDRESS(IF DIFFERENT) �� d • R.Je� �C �L
NUM��R OF FQV��;__ Z�— - - I�ivIBER OF F�NS�OOPS � :'_ 1�1VIBER 0F R�OSTERS � . -
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER l.uDoc� fr3� �'-o✓�c`�=t� t-►oof SIZE OF YARD/PEN AREA l ��X I� '
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS I WATER TROUGHS I
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN _�, Wood -C�P�2r �V�51.c�� ��' � '
��,..
TYPE OF FACILITY USED FOR MANURE STORAGE CpQ�n o '�
METHOD OF DISPOSAL OF MANURE����Y�e�5 '�Gc,k� HOW OFTEN c�V�G�o L n q
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? f,v�oc� � W l�('�.
✓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.
_ �'vwn vf Yarmouth taxes and liens mnst be pair�prior ta renewal c�rissaar.ce af yourpermits. __ __ _ _--__ _—
Please check appropriately if paid: Yes No � /�
!
SIGNATURE
h Y(i{-c � DATE C 2 �� L S
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: `�POULTRY: 1-9 chickens $30.00
10 or more Chickens $40.00
'� ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE: $ W D�NER_
10/14/15
�
I
i