HomeMy WebLinkAboutApplication �I�-�o� �o �P- �5 -12�5-�2-
� °� �� TOWN OF YARMOUTH Boardof
� � Health
= 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHIJSETTS 02664-24451
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��'E Telephone(508)398-2231,ext. 1241 Heal�`f
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Fax(508) 760-3472 � " :
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APPLICATION FOR OPERATION—2017 c� JAN � 7 Z��]
POULTRY �
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PLEASE COMPLETE ALL QUESTIONS � ' ` � ��}�-
E-MAIL =�� � � .
NAME � (� �Z�� ��.J-C� HOME TEL.NO. SU�S ' 3ct�( " ����
LOCATION ADDRESS ��j�� V��� "� S•� ,
MAILING ADDRESS(IF DIFFERENT)
NUMBER OF F(1RIL --- L NLJMBER 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� SIZE OF YARD/PEN AREA � a��w
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS WATER TROUGHS 3
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN yv�-�-,�. �z�v,.,�s,
TYPE OF FACILITY USED FOR MANURE STORAGE
METHOD OF DISPOSAL OF MANURE �c,�,�.�,5�,..�,✓ HOW OFTEN � �,u��
.
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 check appropriately ifpaid: Yes ✓ No
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SIGNATURE -��� DATE `,l�t"I
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: �POULTRY: 1- hi 1 �30.00
or more Chic cen 40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE: $ �O.D�
12/12/16