HomeMy WebLinkAboutApplication �1�-60� a��P-15-1229-02
� °� r TOWN OF YARMOUTH Boardof ���
�' �� Health
= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-2 51
�,�Eo REC�,l�p
Telephone(508)398-2231, ext. 1241
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F�(508) 760-3472 FE� 15 20i 7
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APPLICATION FOR OPERATION -2017 ��H ��� "'
POULTRY C����
PLEASE COMPLETE ALL QUESTIONS
E-MAIL f J � � '(11G�c\, CQN�
NAME HOME TEL.NO.CS����u �?O l
LOCATION AD SS c���tf1G l_l�I�Q l'.v��(,'lf�M('�_1r}'1n� G���
MAILING ADDRESS(IF DIFFERENT)
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`���`�`��Q� (J�t� SIZE OF YARD/PEN AREA
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS , WATER TROUGHS �iq
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN (��1�[J�► �1C1
TYPE OF FACILITY USED FOR MANURE STORAGE�C��1!�C�c� C�1
METHOD OF DISPOSAL OF MANURE ��M� HOW OFTEN
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING?�`�,(��P PS(�C�IC��
� 1 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
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SIGNATURE ' �"��� � DATE �`�l� �,�
THE FULL POULTR UNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: _�POULTR • -9 chick $30.00
or more Chickens $40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE:$ �O . O O
12/12/16