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w�xEE$E 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664- 445�ER � r��l
''��' Telephone(508)398-2231, ext. 1241
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F�(508)760-3472 HEALTH DEPT.
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APPLICATION FOR OPERATION -2017 ���' .�;���.+'���
SHEEP/GOATS FE -$r �'m < _�30:OQ=�f
9 or more anirrials"�$3�b�
Renewal
PLEASE COMPLETE ALL QUESTIONS New Application
E-MAIL o � � � M C.Q��M�Py
NAME � c, � HOME TEL.N . SO� ��� - �/��/ �
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ADDRESS I� %lI/!� C ( C�/J � � �'� O2� 1J
MAILING ADDRESS(IF DIFFERENT) _
EMERGENCY CONTACT(NAME/PHONE#) � �� � y P�b � �
VETERINARIAN(NAME/PHONE#) ` % C-�.S � � v
TOTAL NUMBER OF ANIMALS (>G
PLEASE NOTE: PLEASE DO NOT INCREASE TI3E NUMBER OF ANIMALS
WITHOUT PRIOR PERMISSION OF THE FIEALTH DEPARTMENT.
PLEASE LIST EACH SWINE/SHEEP/GOAT SEPARATELY:
ANIMAL NAME(IF APPLICABLE) ' }-
BREED N�� ; \�
#YEARS OWNED
COLOR � ,
SEX e{�'►�A
DATE OF RABIES VACCINATION �- -/ -(p -/
DATE OF EEE VACCINATION d - -1 -,� -/7
DATE OF OTHER VACCINATIONS �-'" �/�/pf,y� �- �
TYPE OF STABLE/SHELTER �b� SIZE OF CORRAL AREA c�4 / ,X ��
(WOOD,CONCRETE,ETC.) ( ,/
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN �Vt`Y�rd (�n r� �j ►IV C��I-?/��PG�" ��t/1 �S
TYPE OF FACILITY USED FOR MANURE STORAGE �a_ o S !_
METHOD OF DISPOSAL OF MANURE�'�v � ,� HOW OFTEN � 1'�7t (�� �L)
IS CORRAL/PEN AREA ENCLOSED BY FENCING? YE�NO TYPE � CING L.l�btx'� ��f�
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YF�.�` NO � CYt;�.��Pl`,S
(PLEASE NOTE: POULTRY, HORSES,PONIES, DONKIES REQUIRE SEPARATE LICENSURE.)
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 Yannouth t�es and liens must be paid prior to renewal or issuance of your permits.
Please check appropriately if paid: Yes� No
SIGNATURE J DATE � - � � ��
12/12/16
U P � �3 G'o�Ts