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W1TfACNEEBE 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451 �EE 2 �. Z��6 ,
'°"a�a Telephone(508)398-2231, ext. 124 �„�,� �_,, Health
FaY(508) 760-3472 ° ���';�� `� :- �'���`�' �'�'�'
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APPLICATION FOR OPERATION-Z'�'17 "` '�� -`
STABLE
PLEASE COMPLETE ALL OUESTIONS E-MAIL
NAME . A � HOME TEL.NO. Sfj$ 3�� �5��
STABLE ADDRESS C���� ..Q � - �`Y������ �� ,
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MAILING ADDRESS(IF DIFFERENT)
EMERGENCY CONTACT(NAME/PHONE#)__���l�l "�Jd� �'�" �I I��
- VETERIAIARIAN(NAME/PHONE#) .,�/�J /J.�����
TOTAL NUMBER OF HORSES/PONIES ��� TOTAL NUMBER OF STALLS S
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:
ANIMAL NAME IF APPLICABLE fl/�.� �► � ��q � ,
BREED jl�p p �o f�v�
#YEARS OWNED
COLOR ' �ti b Cr3 P� w 1rv ry�
SEX � � �
DATE OF RABIES VACCINATION I1�1;
DATE OF EEE VACCINATION �- --,.-.__
DATE OF OTHER VACCINATIONS
t
TYPE OF STABLE/SHELTER �„f� SIZE OF CORRAL AREA �X,N SU �
(WOOD,CONCRETE,ETC.)
NUMBER OF HOSE BIB WATER OUTLETS � DRAINS WATER TROUGHS �
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN RNC���(G(�'"�` )
TYPE OF FACILITY USED FOR MANURE STORAGE �WVt/�C,
METHOD OF MANURE DISPGSAL �V+'��P FREQUENCY � � Wk
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? ��.�.0
OTHER FARM ANIMALS MAIN•TAINED AT PREMISES? YES NO �
(PLEASE NOTE: POULTRY, SWINE, SHEEP, CATTLE, GOATS REQUIRE SEPARATE LICENSURE.) �
�RENEWAL
NEW APPLICATION- IF NEW APPLICATION, PLEAS� 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 be paid prior to renewal or issuance of your permits.
Please check appropriately if paid: Yes No
SIGNATUR���� DATE_/� '�(rr �/k�
FEES: STABLE& 1 HORSE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ 50.QQ
12/12/16 A�-
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