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MATTACMEESE 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451 a'r^-�.i-^-� ;-�.;.���-
'°*�°' Telephone(508)398-2231, ext. 1241 �+'a`'"' ` �
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Faa�(508) 760-3472 ; ,� � �`-��
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APPLICATION FOR OPERATION -2017
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAIL
NAME ��c�bt Vl S �Z��v L�� m HOME TEL.NO.���S`'�t�a-��� �
STABLE ADDRESS I �'�i SwYY��fY1�� �� �I c�v'�rYl b tl�- �a`(`�' � '�1� � o����:S—
MAILING ADDRESS(IF DIFFERENT) ► O ��� U�(a;r'�Yl�l��L��c��' I � VI�" P5�� �Z"��
EMERGENCY CONTACT(NAME/PHONE#Z SD� a�� �� 1 � br � �g'�a�1 �v ^ 1 � y �
/ -�6�5 ��`t
VETERINARIAN(NAME/PHONE#)��i� �'a�v �'cj� ��{ '7 `7 (a I So
TOTAL NUMBER OF HORSES/PONIES � TOTAL NUMBER OF STALLS�_
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIMALS
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
PLEASE LIST EACH HORSE/PONY/DONKEY/COW SEPARATELY:
ANIMAL NAME IF APPLICABLE �'-�
BREED
#YEARS OWNED �$
COLOR J-e
SEX
DATE OF RABIES VACCINATION
DATE OF EEE VACCINATION zj /
DATE OF OTHER VACCINATIONS y
TYPE OF STABLE/SHELTER ��j � �`� SIZE OF CORRAL AREA '7 a. X � � -�-�--
(WOOD,C NCRETE,ETC.)
NUMBER OF HOSE BIB WATER OUTLETS �n P DRAINS WATER TROUGHS
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN �G(���/►� � �-or'�c�.c�e �l �
TYPE OF FACILITY USED FOR MANURE STORAGE�a�t�-v�e P��"
METHOD OF MANURE DISPOSAL (,� S� �� 0,�,�r���_ FREQUENCY l J P r L''�
/ l
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? �C�S� / l('Cl� I
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO I�
(PLEASE TE: POULTRY, SWINE, SHEEP, CATTLE, GOATS REQUIRE SEPARATE LICENSURE.)
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
SIGNATURE ���.�, � ��1� ��J� DATE ��,- /�- /�
FEES: STABLE& 1 HORSE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ 35 .�
12/12/16
U P �rr� 2 +�sEs P�e 20/6 �}PP.