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°� r TOWN OF YARMOUT Bo�daf
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w�� = 1146 ROUTE 28,SOUTH YARMOUTH,MASSACHIJSETTS 02664-2 51 Hea
'++��' Telephone(508)398-2231, ext. 1241 U E.l: �1�����
Fax(508)760-3472
HEALTH DEPT.
APPLICATION FOR OPERATION-2016 '
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAIL 1tiiC i VI�-r.tre d( � c°���s�.'�'�+ ':
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NAME��Ot�-��C�t.{ �(ylrM HOMETEL.N0.51J8-'-�f3S-��0�
STABLE ADDRESS L O E �f 0..c� �C��wl � • � • , �/I�'N�o U'�'� 1��"�
MAILING ADDRESS(IF DIFFERENT) � C'� ��X ��
5a8-38s- a"�
EMERGENCY CONTACT(NAME/PHONE#)��� � ��r` M'����L►re C e�t = So���Z 3�-07�
VE'F�I:IP����1�7�FARqE/PI�OP3E�� 7"l �� ���-� �b� - 3 C� �- `�j� �L _ ---
TOTAL NUMBER OF HORSES/POI�TIES � TOTAL NUMBER OF STALLS
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIMALS
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
PLEASE LIST EACH HORSE/PONY/DONKEY/COW SEPARATELY: do r�k� s '
�^ C o(,.�5 -`1 �
ANIMAL NAME IF APPLICABLE co F�onCL. G-w� Ne or
BREED ea , lk� l aF- Ffi �.1��� Med, iM�n i Med- nti t vt i
#YEARS OWNED �2 I 2 "7 '
COLOR dk. bld o d e. re wh�-t
SEX (i A-+"1
DATE OF RABIES VACCINATION � �S 4 i `� '� 5
DATE OF EEE VACCINATION � � � �S
DATE OF OTHER VACCINATIONS
TYPE OF STABLE/SHELTER WGv� SIZE OF CORR.AL AREA 20>c2o -t- {�a�s-E-�f�
(WOOD,CONCRETE,ETC.)
NUMBER OF HOSE BIB WATER OUTLETS 1 DRAINS WATER TROUGHS I
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN c�c�l va.n�z-e� ��r2�5
TYPE OE FACILITY USED FOR MANURE STORAGE Qo nti-Pb�'�
METHOD OF MANURE DISPOSAL q arcl,��,��s v Se FREQUENCY �v�c�o t y�q
— _--- - --- -----_-
____ ___— _ _ _ _ --- - --- _ __ ___
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CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? in�t>oc� r� c.-��r'�
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 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 taxes and liens must be paid prior to renewal or issuance f your pernuts.
Please check appropriately if paid: Yes No �l �(�
SIGNATURE ��yLt,C, J v`�e C�.�t�c-t�tx- DATE t� �� �S
FEES: STABLE& 1 HORSE $30.00(+$5.00 each addirional horse/animal) TOTALDUE:$ ���V�
10/14/IS
� LocST l.�c.ENSE : 2 coWs j Z MiN� VoNk�-iS
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