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� °F ` TOWNOFYARMOUTH Hardof � �,�
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= 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-2 -
o„�EaE REC
Telephone (508)398-2231,ext. 1241
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Fax(508) 760-3472 �F� '� 5 2Q��
APPLICATION FOR OPERATION-2017 H�AL-TH DEPT
POULTRY �_.�' �
PLEASE COMPLETE ALL UESTIONS � �`��^��r���,
E-MAIL�c5t�c� �0,0�v�z�'f�M
NAME (kS HOME TEL.NO. �� �m�e Y ' �oM
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LOCATION ADDRESS I g P�'��R(a C'�'Q��JrjL? 7 R�n'0✓�i Ofi� I✓1� �'i�� 7 S
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. f �
TYPE OF SHELTER �'�a �r�- SIZE OF YARD/PEN AREA ° � ;X ��
(WOOD ONCRETE,ETC.)
NUMBER OF WATER OU LETS � WATER TROUGHS �
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN ��uc��,,� w��h C'A�-pl'�� �Cr SI1 <'c�/In C •�;�
TYPE OF FACILITY USED FOR MANURE STORAGE Ca- a5 1
� 2 /�,
METHOD OF DISPOSAL OF MANURE �`V HOW OF EN�( V MONQ G�
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? (ti3 i('-2., � i�i�d
; v�NEWAL
! 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 ta�ces and liens must be paid prior to renewai or issuance of y�ur permits.
Please check appropriately if paid: Yes�No
/� �
SIGNATURE � DATE �— / �/ �
THE FU O COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: �POULTRY: 1-9 chickens �
10 or more Chickens
� ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE: $ �O Y OV
12/12/16