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APPLICATION FOR OPERATION-2017 � ���£ ����h �
POULTRY � � �
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PLEASE COMPLETE ALL QUESTIONS �w� -~----�
� E-MAIL _ 1
NAME � � �� � HOME TEL NO. �����1/
LOCATIONADDRESS ��/I/� ��j/��'�' �� ����� Oo��l�7'
_ /
MAILING ADDRESS(IF DIFFERENT)
� 1tiriJMBER OF FOWL _ � NUMBER OF PENS/COOPS�__�, NUMBER OF ROOSTERS �'
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PE ISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER O SIZE OF YARD/PEN AREA I� �C�
(WO ,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS WATER TROUGHS 1
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN 'Tl � /`7hv i� � � �
TYPE OF FACILITY USED FOR MANURE STORAGE (_ � f7��
METHOD OF DISPOSAL OF MANURE N � HOW OFTEN �—
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? �"S�<<—^ � �
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 Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits.
Please check appropriately if paid: Yes No
SIGNATURE DATE �(/� i�t�
THE FULL PO RY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: �POULTRY -9 chickens �30.00
ickens 40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE:$ 30��O
12/12/16