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� ` TOWN OF YARMOUTH Boardof
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�E�E = 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 0266 -24����d��
�i° Telephone(508)398-2231,ext. 1241 Health
Fax(508)760-3472 ��.L � ������n
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APPLICATION FOR OPER�'��N 2016 g2, ��� HEALTH DEPT.
STABLE ���� '
PLEASE COMPLETE ALL OUESTIONS E-MAIL ��
NAME �5 i���•;Z f✓ !.� <I`�1�`��'Q � HOME TEL.NO.::�'''/IS"3�!�'l ?� 8"��
STABLE ADDRESS 7 ��S'��'�G�iI6L�✓'�i �-���
MAILING ADDRESS(IF DIFFERENT) ,�¢�� ,_y� C�r��3¢�'L f'�-r'� d''d� 3 6 � �L `�`
EMERGENCY CONTACT(NAME/PHONE#� S7�S� �-� � �SI � �
_ _
__-- _- ___ — ___ _
VETERINARIAN(NAME/PHONE#)
TOTAL NUMBER OF HORSES/PONIES .:7'�.%¢ TOTAL NUMBER OF STALLS �/i� yd H i
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 ,,;� - ,,, L r�� 2 n�
BREED �+Lv
#YEARS OWNED r� � ,�
COLOR �,,,
SEX
DATE OF RABIES VACCINATION �: 3" r/
DATE OF EEE VACCINATION i S'
DATE OF OTHER VACCINATIONS � �r, -�
TYPE OF STABLE/SHELTER �'���� r c�-.v�-��i�� SIZE OF CORRAL AREA 7.f/,�ya .�t^�s 8�'�/��d '
(WOOD,CONCRETE,ETC.)
NUMBER OF HOSE BIB WATER OUTLETS u-� yG DRAINS /,��ic.i WATER TROUGHS ./,�vIGLG�-r�
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN /�fize-/1 Z i f ,� ���'C�rs-►
TYPE OF FACILITY USED FOR MANLTRE STORAGE d,n 2�
_ __r�r�,-�runri 4F-?�4�TL�gF-���P-0�P�,f''�n--r✓���2F.�n5' G�ssc-�1�../S' —�TTFNGy ,Q7�n-r-v�u-��y -- -
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? !�v-o p � /L Z.�y��–�z.-f��
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO �/
(PLEASE NOTE: POULTRY,SWINE,SHEEP, CATTLE, GOATS REQUIRE SEPARATE LICENSURE.)
�✓ 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 p 'or to renewal or issuance of your permits.
Please check appropriately if paid: Yes� No
SIGNATURE � DATE /v�y>�/�s
FEES: STABLE& 1 HO 30.00(+$5.00 each additional horse/animal) TOTAL DIJE:$ (00•00
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