HomeMy WebLinkAboutApplication �(�O—0���o� P� C S--(�(—6 !
� °� ` TOWN OF YARMOUTH Boardof
+� � Health
= 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451 -
, .0`MEESE Health
; ""�°' Telephone(508)398-2231, ext. 1241
� l�ivici�n
i FaX(508)760-3472
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APPLICATION FOR OPERATION-2016 C� ��G �
POULTRY
� PLEASE COMPLETE ALL QUESTIONS (,�p��...�oP,..�.��j�}-,�r��, �,�,,,�,1, ,�,h
NAME���O,S SI�1�c rn A n d- !� � r�. ��P�M�n HOME TEL.NO.�f �(�7-S//�/
LOCATIONADDRESS � �- GZfo7S
MAILING ADDRESS(IF DIFFERENT)
_ ' �rrtl�uFu nF Fn�a�r IS5 �'�A UA?�RER_OF_PE1�iS/L�9P_S__-__-�_._ _ I�IUMBER_OF RDOSTEB.�_- ---------- ---
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� PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTE 'i SIZE OF YARD/PEN AREA ���S SC, . �•
I (WOOD,CONCRETE,ETC.)
! NUMBER OF WATER OUTLETS ( WATER TROUGHS ��
I 1
; TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN 1.,rr�a�- Sre L-f-e� ��P,si-R,� CCrS � ���� S
TYPE OF FACILITY USED FOR MANURE STORAGE (,�>(�'�� CY��`� e�
METHOD OF DISPOSAL OF MANURE �_�c�(� HOW OFTEN � ��t n-�S �
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? Cy i
` ��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_taaces and_liens must bee�aid ' r to renewal.or issuance of�our.permits. _ _
---- — _ — — _ _--- --
Please check appropriately if paid: Yes No
SIGNATURE DATE ���"I�o
THE FULL POULTRY COUNT IS NOT TO ED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: ✓ POULTRY: 1-9 chickens $30.00
10 or more Chickens $40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS) '
�NO ROOSTER
TOTAL DUE: $ �0.00
10/14/15
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