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oF Y R M U T H Board of $
� � TOWN OF YA O
� � Health
= 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 0266 - - --- --
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Telephone(508)398-2231, ext. 1241 ���' `� �
i�ivisi�n
F�(508) 760-3472_, � ,�. �~ �_
F ����$q� ,IqN U3 2017 �
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APPLICATION FOR OPERATION-2017 __.. � �
POULTRY
PLEASE COMPLETE ALL QUESTIONS '
E-MAIL . t�;�Q�-�Cr►rC'w�G, t�e�
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NAME DI l��� �,1�"�"��,� �'� HOME TEL.NO.(�6�5 '3LJ�$G Z'�i
LOCATION ADDRESS (f�� ���.�e�. � ��`?�l�o-•��^- �"�� �3
�" � . t _�
MAILING ADDRESS(IF DIFFERENT) t/�
__ NUMBER OF FOWL 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 Cv7�bKa�.d-C'.�u��a SIZE OF YARD/PEN AREA�Ca� ��
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS ��y ,3 WATER TROUGH���� �{
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN �#�(�N�
TYPE OF FACILITY USED FOR MANURE STORAGE � ,�j��E�^'�
METHOD OF DISPOSAL OF MANURE ��s�Sa'��.e/ HOW OFTEN �, �+^�
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING?
�RENE WAL
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 p ' r to renewal or issuance of your permits.
Please check appropriately if paid: Yes No �
� �� �� 1 �
SIGNATURE DATE
THE FUL L COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: �POULTRY: 1- chi $30.00
or more ic ce $40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE: $ O.O�
12/12/16
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