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,�4�' °� ` TOWN OF YARMOUT . °EBo�����
►= � HEALTH DEPT.
W�c = 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24 Health
''�� Telephone(508)398-2231,ext. 1241 �
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Fa7c(508)760-3472 �"' '. , ���(E,�� ���',
APPLICATION FOR OPERATION-2016 '�P�o'�
STABLE
PLEASE COMPLETE ALL OUESTIONS E-MAIL
NAME �G�(J�fl C • �O�-�1 ��I � HOME TEL.NO. JrC�S'.3�on�'"�O�lg
STABLEADDRESS �S� SU� �(11 '�C�� S'��(J�Y'.�1(\ LA`1'V1 (�O�'k�� � D�C47y�
MAILING ADDRESS(IF DIFFERENT)�o)C r��� � (7�Y�M()U.`��OG'`�' � �Q�1� C� CU _Z S�
EMERGENCY CONTACT(NAME/PHONE# i�U-r�-S - � I � "' � ��� �
---- __ ___ _ - — - - - __ -- — --
_ _ _ E
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VETERINARIAN(NAME/PHONE#) �Y1 �(�1,C� �� � ��- ��'( �]�' �CO�
TOTAL NUMBER OF HORSES/PONIES_� 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:
ANIMAL NAME IF APPLICABLE �'
BREED
#YEARS OWNED
COLOR '
SEX '
DATE OF RABIES VACCINATION
DATE OF EEE VACCINATION
DATE OF OTHER VACCINATIONS ` t�
TYPE OF STABLE/SHELTER l�O�Z7 SIZE OF CORRAL AREA �� X � �
(WOOq CONCRETE,ETC.)
NUMBER OF HOSE BIB WATER OUTLETS �(1 e, DRAINS WATER TROUGHS
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN G'C�,ti(1 ��(1 S ��'0�,� (J'�C�o`��
TYPE OF FACILITY USED FOR MANURE STORAGE +j�{�Q,(��►„�;� U�SC. ��L'�:�� S
________ MFTHQRQFMANTJRRI�TSPnS�, �C�� lA\�E' US����'�1SFREQUENCY _
--��r _ � C �
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? ` S
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO ✓�
(PLEASE NOTE: POULTRY,SWINE,SHEEP, CATTLE, GDATS REQUIRE SEPARATE LICENSURE.)
�RENEWAL
NEW APPLICATION- IF NEW APPLICATION,PLEASE ATTACFI A COPY OF PLOT PLAN SHOWING LOT
LINES AND LOCATION OF STABLE, PEN,ETC.,AND ALL ENCLOSURES. ALSO,A
WRITTEN LETTER OR STATEMENT,5IGNED BY ALL ABUTTERS TO PROPERTY.
Town of Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits.
Please check appropriately if paid: Yes�,�"No
SIGNATURE t lC�J� S ��Y\ �J t o ` DATE �o�- -I "' o�O I S-
FEES: STABLE& 1 HORSE $30.00(+$5.00 each addirional horse/animal) TOTAL DUE:$ .�-rj•O�
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