HomeMy WebLinkAboutApplication �I�-bld���P-�5-��3-02-
� Y T O �V N +� F Y A R 11�I O U T H Board of
� Heaith
114b ROUTE 28, SOUTH YARMOUTH,MASSACHt3SETTS 02664-24451 "
'�'' Telephone(508)398-2231,ext. 1241 �'���� �����
Fax(508) 7b0-3472
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APPLICATION FOR UPERATI �;�U�.�`;1 ,�� �,�-n q-�-e_4 ;, _,;. �
POULTRY � , . , , .-�.
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PLEASE COMPLETE AL L OUESTIONS
' ' E_1�I�. HEYSANDY@CAMPWK.COM
NAME SANDY RUBENSTEIN HOME TEL.NO. 50&362-3798
LOCATIONADDRESS CAMP WINGATE*KIRKIAND
�tt,ttvG ADt�xEss(tF�tF�Et�rrT} 79 WHITE Rt}CK ROAD YARMOUTH PORT, MA 02675
I��llMBER OF FOWL 14 NUMBER OF PENS/COQPS � NUMBER OF ROOSTERS Q
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER (3F FOWL
WITHQUT PRIOR PETZMISSIQN OF THE FIEALTH DEPARTMENT.
' TYPE OF SHELTER WOOD SHED �IZE QF YARD/PEI�i AREA 2O' X ZO'
(WOOD,CONCRETE,ETC.)
P�t1MBBR�F WATER OUTLETS � WATER TRQUGHS �
�pE o�s�'oxa��FActL1TY us�D FOR F�EDicRatN 7'UPPERWARE TRUNK INSIDE GARAGE
fiYPE OF FACILITY USED FOR MANURE STORAGE RUBBER COMPOSTER
METH�D OF DISPOSAL OE MANURE COMPOST OR RUBBISH HOW OFTEN WEEKLY
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? 1�2 x 48 INCH HARDWARE CLOTH
** Inspector may find it more convenient to access coop from Camp entrance at 20 Linnell Lane.
X RENEWAL
NEW APPLICATIQN- IF NEW APPLICATIOIY,PLEASE ATTACH A COPY QF PLOT P�.AN SHOWiNG LOT
LINES Ar1D LOGATION O�STABLE, PEN, ETC.,AND ALL ENCLOSURES. AISO,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 appropriatety if paid: Yes No
.
SIGNATURE � aATE DECEMBER 19, 2016
THE FULL POULT OU T IS NOT TO EXCEED THE AMOUNT QF PRIOR YEAR'S TOTAL.
FEES: �POUL : 1-9 chickens $;�
10 or more Chickens �=��t��
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED Ft�R ROOSTERS)
NO ROOSTER
TOTAL DUE:� �O• C1 O
12i12 IG