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� Heal
z HEALT DEPT.
� � 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-2445
� '''�'' Telephone(508)398-2231,ext. 1241 c�-��-� ��ealth
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Fax(508)760-3472 � �
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APPLICATION FOR OPERATION-2016 •
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� PLEASE COMPLETE ALL QUESTIONS E-1v1�L
� NAME��qr�� C�� ��. HOME TEL.N0.�d���� �i-1bS6
� STABLE ADDRESS i bp w,lr�10�.t G�� ►, Iaes�-- t.�,q��w�
4 SOF����6�i
MAILING ADDRESS(IF DIFFERENT) '`l35 L-,n°1 Q��� �r�UQ ��+n w'��''��a� da�WS �
EMERGENCY CONTACT(NAME/PHONE# `r�{`�'^�"� c�� l` S�-Y3� '�b� D I�60'�6��
'_ -- —VETERINARIAN(NAME/PHONE#)�•��\Cl ii�Q�f'�h�`�1'�. �"'�: *�Tv�111��� 1 �'S��-4`�"1-33�
f TOTAL NUMBER OF HORSES/POTTIES �C 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 SEPARATELI':
ANIMAL NAME IF APPLICABLE r" c� u al
BREED ivt �Y'
#YEARS OWNED 13 e4r
COLOR 81 • tg� Q�yy�w►n�,d�
SEX
DATE OF RABIES VACCINATION (
DATE OF EEE VACCINATION �
DATE OF OTHER VACCINATIONS �jq
� S l/ lo � ' ��3°�
TYPE OF STABLE/SHELTER WU�� SIZE OF CORRAL AREA L(��p� �/d f��
(WOOD,CONCRET ETC.)
NUMBER OF HOSE BIB WATER OUTLETS � DRAINS WATER TROUGHS �D �
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN �";h 1pcWtl'..q,��
TYPE OF FACILITY USED FOR MANURE STORAGE �1,��d-�p�'P�1�
METHOD OF MANURE DISPOS_��S' �1f�a'!!'i"Q.,� ��C��✓'a"J _FREQUENCY V^�� __ __ _;
� (� -----� -.. ----
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? �aU�- � C,�IQ,�'�/� { �'��
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,prior to renewal or issuance of your permits. '
Please check appropriately if paid: Yes ✓ No
SIGNATLJ�Zb\11����sIC�.V� �GQ � ���/l�ii„ �_�DA�F �� : � -'f'T"�"�
FEES: STABLE& 1 HORSE $30.00(+$5.00 each addirional horse/ammal) TOTAL DUE:$ 40.OO
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