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� °� � TOWN OF YARMOUTI� _ .
� e Board of u
� e Health
��a = 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHLTSETTS 02664-24�51 -
Telephone(508)398-2231,ext. 1241 � �AN ���0�7
F�(508) 760-3472 F` F : � ivicinn fi
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APPLICATION FOR OPERATIO��20�'l-s. � °�--�= J
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAtL 'IJub�N�a Q.��,�U� - ��
NAME ,1/►�f"��Q G �G�,i("�`�I� , HOME TEL.NO. b��� �^ y�j.j,Ci
STABLE ADDRESS � � 4'y� l�J'
�v�'-7�b -$�at
MAILING ADDRESS(IF DIFFERENT)�� � �,�j�� � � �I
EMERGENCY CONTACT(NAME/PHONE#�,�j�,�,�I�I�tQ,� �f`��S ^ 1 / � ` ��c�� W�
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VETERINARIAN(NAME/PHONE#) '�'��.�(�(ItFt b$�l�i ���(,`�� ��
TOTAL NUMBER OF HORSES/PONIES�_ TOTAL NUMBER OF STALLS `�_ �
PLEA5E 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 Q
- #YEARS OWNED � �O r
COLOR ;�.k'i
SEX {� �
DATE OF RABIES VACCINATION t,�;
DATE OF EEE VACCINATION
DATE OF OTHER VACCINATIONS �
3 ��o�
TYPE OF STABLE/SHELTER ��� � SIZE OF CORRAL AREA y�y� '� o�^„�_
(WOOD,CONCRETE ETC.)
NUMBER OF HOSE BIB WATER OUTLETS � DRAINS WATER TROUGHS �
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN f 9�,k� ��,(7�'�,I�
TYPE OF FACILITY USED FOR MANURE STORAGE g�l�
METHOD OF MANURE DISPOSAL ��,r,w�� FREQUENCY ��. �+A,+I�I
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? t��� { �" ��
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO �
(PLEASE NOTE: 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 rior to renewal or issuance of your permits.
Please check appropriately if paid: Yes� No
SIGNATU � C[C� DATE � — �- I`�
.
FEES: STABLE& 1 HORSE $30.00(+$5.00 each additional horse animal) TOTAL DUE:$ �{0. Q 0
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