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= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-244 1 ,. ���'�����
"�•� Telephone(508)398-2231 ext. 1241 i Heatth ;
Faa�(508)760-3472 �:.� ": ` D��'������ �
� �'�� �� �£ HEALTH DEPT. �
APPLICATION FOR OPERATI 2 �(�6 r�a���
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAIL����g�_Q��`c`�•��'n E
NAME c�c� ��sc��ObSS HOME TEL.NO. �A� ��Sp�(� �
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STABLE ADDRESS��, C�rollCc,C l.l ',
MAILING ADDRESS(IF DIFFERENT)
EMERGENCY CONTACT(NAME/PHONE#�C`c�i'�. �C1`�.- ��j� •' ��t'��
- -- (QArv1E%FHOI�E-#) - __—_
— - - . _ — r - - -
TOTAL NUMBER OF HORSES/PONIES�_ TOTAL NUMBER OF STALLS�O ,���/�
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIMALS �y�- „
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT. ����R�. ;
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PLEASE LIST EACH HORSE/PONY/DONKE�OW SEPAR�ATFiI.Y: / � ✓ �✓ -}��j �"j 1-�"�j '
,/ �✓
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ANIMAL NAME F APPLICABLE m��
BREED 'c
#YEARS OWNED 3 � ''�
COLOR P°'ti°s`�'ns ,
SEX t�c�c��. '
DATE OF RABIES VACCINATION - 5-t'� '
DATE OF EEE VACCINATION ' • 5^��
DATE OF OTHER VACCINATIONS - � � S��S '
TYPE OF STABLE/SHELTER��, CC'1C�C'CZ� SIZE OF CORRAL AREA�-�C�- \�SJXCrJd
(WOOD,CONCRETE,ETC.) 'C1�
NUMBER OF HOSE BIB WATER OUTLETS '�`a, DRAINS ��_WATER TROUGHS *'�
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN�c��C��S
TYPE OF FACILITY USED FOR MANURE STORAGE ��p� -
METHOD OF MANURE DISPOSAL � ,.)b,_��c., FREQUENCY �`y��,���
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CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING?� ncu�, ��.c�C�� c�)�C�
OTHER FARM ANI1v1ALS MAINTAINED AT PREMISES? YES NO_��
(PLEASE NOTE: POULTRY,SWINE,SHEEP, CATTLE, GOATS 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,SIGNED 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 I
SIGNATURE DATE�,._i�`� ��l
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FEES: S E& 1 SE $30.00(+$5.00 each addirional horse/animal) TOTAL DUE:$ (�() _
ioitans
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