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''*�'' Telephone(508)398-2231, ext. 1241
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FaY(508)760-3472 HEALTH DEPT.
APPLICATION FOR OPERATION-2016
SHEEP/GOATS FEE: 1-8 animals $30.00
9 or more anim�
Renewal �n1A I V�D
PLEASE COMPLETE ALL QUESTIONS New Application
E-MAIL MCtV1�'H�d� � CvA1C0.5'�•f��'�
NAME'��,i lo r-13 raU �ct.rn� HOME TEL.NO.
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ADDRESS 1 O� Pj�ac,� �arn�t �cV ,fJ= � (�1arn��, Po��
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EMERGENCY CONTACT(NAME/PHONE#)�/1 � �,1,'v�V� t�Y1�C � yl�'U(^e �e ( Sog-�3'7-G"76 �r 5�8
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VETERINARIAN(NAME/PHONE#)�Q.('I Vl t��QI� So S � '�6 Z-?.�-6/{�
TOTAL NUMBER OF ANIMALS g
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIMALS
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT. :
PLEASE LIST EACH SWINE/SHEEP/GOAT SEPARATELYv.��S � ��e �-1
ArTIMAL NAME(IF APPLICABLE) �v 5 'D U s �Gl. G n o n 0. �S � C�PS
BREED u b� o� u►,, o� U,(,`t�urra �q,V_ �u o
#YEARS OWNED ,� --1 � -7 (o Z
COLOR $ra u�n -{-a.(h �e� a�.c� r ��ea.�u 6� �) '
SEX R M f�' M '
DATE OF RABIES VACCINATION -� �c, � t<, �� �5 -� �
DATE OF EEE VACCINATION
DATE OF OTHER VACCINATIONS -� � 7 /5 `� !�j � �
TYPE OF STABLE/SHELTER l•�ood � �re� SIZE OF CORRAL AREA 3o Xs{ b
(WOOD,CONCRETE,ETC.) r�
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN �j'�Z.�Ve'i.ui62�� p�f'c'�.1
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METHOD OF DISPOSAL OF MANURE q Q,(�t��V\e�('S T�e HOW OFTEN O�q o� h.Gj
IS CORRAL/PEN AREA ENCLOSED BY FENCING? YES✓NO TYPE OF FENCING (.��OC� � W 1('�'-
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YE��NO
(PLEASE NOTE: POULTRY,HORSES,PONIES,DONKIES REQUIRE SEPARATE LICENSURE.)
IF NEW APPLICATION, PLEASE ATTACH A COPY OF PLOT PLAN SAOWING 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 of your pernuts.
Please check appropriately ifpaid: Yes No (�3��
SIGNATURE S"1 � DATE j Z ��G J�
10/14/16 '