HomeMy WebLinkAboutApplication �!?—o �Z �6�4 P..�s—�2�`f—o-Z
� °� r TOWN OF ARMOUTH Boardof a ���
� � Health
���E = 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 0266 -24��„�; ���
Telephone (508)398-2231,ext. 1241
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F�(508) 760-3472 DEC 2 3 2016
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APPLICATION FOR OPERATION -2017 � '�
POULTRY �' °
. CA`.r'' � �`�,
PLEASE COMPLETE ALL OUESTIONS " ��Y`t
E-MAIL . s. . _._9
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NAME Cr��IL' ����SU•� HOME TEL.NO. ,.7 JY- 7 7�-GS/7
LOCATION ADDRESS�(���,�s C��rr��// ,�i'�, ��d�t�„iC�;� /�''J,.¢ �2;1 G' 7�'
MAILING ADDRESS(IF DIFFERENT)
NUIvIBER OF FOWL �`3"� NUNIBER OF PENS/COOFS -� NUMBER OF ROOSTERS 'j�
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER SIZE OF YARD/PEN AREA
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS WATER TROUGHS
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN
TYPE OF FACILITY USED FOR MANURE STORAGE
METHOD OF DISPOSAL OF MANURE HOW OFTEN
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING?
✓ 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 cHe�k appropriately if paid: Yes �,.-" No - -
SIGNATURE �.,,.�_,�� ��� �, _ DATE /'��/��/�
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: �POULTRY: 1- chickens �30.00
or more ic c 40.00
�ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE: $ O.00
12/12/16