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�t'��O' BO k�SG���-I Z.y-�,—0( a�'S�u'�'�i�
� ` TOWN OF YARMOUTH M�� � � �o��
� � Board of
HE��'t�i DEPT.
= 1146 RnUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-2�451 -
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'�� Telephone(508)398-2231,ext. 1241 �`�� _ 1��''! '� �'
Faa�(508)760-3472 j ::;.� ?
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APPLICATION FOR OPERATION-2016
SHEEP/GOATS FEE: 1-8 animals $30.00
9 or more animals $35.00
�Renewal
PLEASE COMPLETE ALL OUESTIONS New Application
I E-MAIL c� oua�Z �S-�p � b�T�-om (!����p ,
NAME�4�f c,� �- L.O�.c�� -..�'T1 t�T/t�G/1 HOME TEL.NO. _S'�D�' !�c��I �G(lh
ADDRESS�IS P;nc��� f� L-�.-�-.n y �Ot�- rn� (�fo�s
� __ _ MAILING ADDRESS(IF DI�'FEREI�IT�_---- --- ---_ -- — _ ___ - -- --
EMERGENCY CONTACT(NAME/PHONE#) �, 10� s 5n�e�m� "7�L/-�9y�����
' VETERINARIAN(NAME/PHONE#)--_�(Z. �YIA4i J�G�C'�AQ ���'�(� �SU
TOTAL NUMBER OF ANI1v1ALS �
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF AIVIMALS
WITHOUT PRIOR PERNIISSION OF THE HEALTH DEPARTMENT.
PLEASE LIST EACH SWINE/SHEEP/GOAT SEPARATELY:
1
ANIMAL NAME(IF APPLICABLE) •� '� �
BREED �
#YEARS OWNED
COLOR c N
SEX � -�
DATE OF RABIES VACCINATION g� �- s -( --i
DATE OF EEE VACCINATION -%S -i -o
DATE OF OTHER VACCINATIONS ..t r �
TYPE OF STABLE/SHELTER W�d� SIZE OF CORRAL AREA ��J `P�'�- `� '
(WOOD,CONCRETE,ETC.)
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN M���( P n C(C�.R'� C on�-s iNN/c �`Lv t�.-cxx.!P�j
TYPE OF FACILITY USED FOR MANURE STORAGE�_d-
�_ ___ __-- _—_ ---- --- ---
_ _ _ - ---- - _ —_ _
METHOD OF DISPOSAL OF MANURE �ti��� HOW OFTEN ��e �l-Y
' ____ � ,
f IS CORRAL/PEN AREA ENCLOSED BY FENCING? YE�O TYPE OF FENCING �,� c�.i r�
OTHER FARM ANIIVIALS MAINTAINED AT PREMISES? Y$�Q� NO �6 t��-Fy c•� �:Gke r��'
(PLEASE NOTE: POULTR"Y,HORSES,PONIES,DONKIES REQUIRE SEPARATE LICENSURE.)
IF NEW APPLICATION, PLEASE ATTACFi A COPY OF PLOT PLAN SIiOWING 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 tax s and 'ens must be paid prior to renewal or issuance of your permits.
Please check approp ately if aid: Yes �� No
SIGNATURE DATE � 'c� ('� �(� :
10/14/16
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