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� °� �� TOWN OF YARMOUTH Bo�dof �����
� g Health
= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451
�"�° Telephone(508)398-2231,ext. 1241 -��-.�� _ _„�__�
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F�(508) 760-3472 �
JAN 19 2017 �
a
APPLICATION FOR OPERATION - 2017
POULTRY � � �� �
�,� .�
PLEASE COMPLETE ALL QUESTIONS � �'� ��'
E-MAIL� /�{ V (�y�,��
NAME�,{��;Q����'��� ` HOME TEL.NO. �Q n " ,��'��
LOCATION ADDRESS �'"t' �' �"l�h L�T
MAILING ADDRESS(IF DIFFERENT)
NUMBER OF FOWL ,.J NUMBER OF PENS/COOPS ` NUMBER OF ROOSTERS
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
� WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
�' TYPE OF SHELTER �bC� �J�. ���t/J SIZE OF YARD/PEN AREA � ��'
{ (WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS � WATER TROUGHS G-
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN G1 C �(/)'1 'G� ��'1
—� _
TYPE OF FACILITY USED FOR MANURE STORAGE �je�� �
METHOD OF DISPOSAL OF MANURE Cj(JYYbG� � HOW OFTEN ���,�(�,fy��
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? ��/U(/K,r�i-]'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 taYes and liens must be paid prior to renewal or issuance of your permits.
Please check 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- $30.00
or more Chic cens $40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
�_NO ROOSTER
TOTAL DUE: $ �O,O O
12/12/16