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°� ` TOWN OF YARMOUTH - , ����,
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= 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664- 45 D PT•
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Telephone(508)398-2231,ext. 1241 ����g�� � .,
Fax(508)760-3472 �� �� �(p`, ��
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�` APPLICATION FOR OPERATION-2016 �� �� 4� b""
f STABLE
- - __PLEASE COMPLETE ALL QUESTIONS E-MAIL����"�S ��T� ���
—-- _ _
NAME �r rAR �� -- HOME TEL.NO.�� SS�
STABLE ADDRESS ���- � IJ� 1'1'�7 IJ S%1 � � _ -. -
MAILING ADDRESS(IF DIFFERENT)
EMERGENCY CONTACT(NAME/PHONE#1 W A �rO� �JD� �l'I -` t � V
_ VETERINARIAN(NAME/PHONE#)�� yV A6�a 1l��-
TOTAL NUMBER OF HORSES/PONIES S 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:
ArIIMAL NAME IF APPLICABLE i �� �Q/�}a GR
BREED A AG�.tA A
#YEARS OWNED ,
SEX ` !'hA rrl ----
DATE OF RABIES VACCINATION �
DATE OF EEE VACCINATION h -
DATE OF OTHER VACCINATIONS b
TYPE OF STABLE/SHELTER w0�.� SIZE OF CORRAL AREA �r"xj�Z Sf��
(WOOD,CONCRETE,ETCJ
NUMBER OF HOSE BIB WATER OUTLETS � DRAINS WATER TROUGHS 3
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN �+V�(9UIp �li�I/�Cj
TYPE OF FACILITY USED FOR MANURE STORAGE�/'C�Q�
._METHQD OE MANT TRF DISPOSAL -�hVLf_C�_O�,�V mP `E��L��'fj FREQUENCY � _�`1s___ _ __
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? �"�7�,�
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO ✓
(PLEASE NOTE: POULTRY,SWINE,SHEEP, CATTLE, GOATS REQUIRE SEPARATE LIeENSURE.)
�RENEWAL
NEW APPLICATION- IF NEW APPLICATION,PLEASE ATTACIi A COPY OF PLOT PLAN SHOWING LOT
LINES AND LOCATION OF STABLE, PEN,ETC.,AND ALL ENCLOSURES. ALSO,A i
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 permits. i
Please check appropriately if paid: Yes_� No
SIGNATURE ���C_,0��o DATE Io� 'I��'��j
FEES: STABLE& 1 HORSE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ ��.�
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