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� r TOWN OF YARMOUT Bo�dof
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= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664- 445 � ;
�° Telephone(508)398-2231, ext. 1241 �U� � ���
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FaY(508)760-3472 HEALTH DEPT. �
APPLICATION FOR OPERATION -2016 E r � � � �-
POULTRY �'`$ � f
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PLEASE COMPLETE ALL QUESTIONS
E-MAIL ,.y'i�e%c.laz�� �s�G r�r/„Co.ti,
NAME S^l�l+ey) F-�l�t�.Q HOME TEL.NO. 7 75� 99 5� �Yl/
LOCATIONADDRESS /f�� �D.V�7ts.YICe G4t�� t,V�S C V re�a�x �t k�SS �a673 �
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MAILING ADDRESS(IF DIFFERENT) !
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PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER C�t��{ Sh� SIZE OF YARD/PEN AREA � �k �� ^
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS � WATER TROUGHS �
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TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN �� CO�17,,;5 u�� (x��
TYPE OF FACILITY USED FOR MANURE STORAGE �f�'l,OaSl ��
METHOD OF DISPOSAL OF MANURE ��i�{'/�P.�t/S HOW OFTEN V�Pcue1l/
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? l�y /`�'�� .�C�'�!/J
+� 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 Y rmo�h xec and lien�mLst h�,}�aid tnrarf p rene�ual__�.isSuanCe_of YouLU���rs- _
Please check appropriately if paid: Yes E/ No ~
SIGNATURE ` DATE �/ /.S-�/�
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
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FEES: `/ POULTRY: 1-9 chickens �30.00
10 or more Chickens 40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER i
TOTAL DUE: $ 3p_O�
10/14/15