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�. °� TOWN OF YARMOU EAi�" _
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1146 ROUTE 28,SOUTH YARMOUTI-I,MASSACHUSETTS 02664-24451 Health
�'' Telephone(508)348-2231,ext. 1241
Fax(508)760-3472 �ivici�n
� APPLICATION FOR OPERATION-2017
SHEEP/GOATS FEE:1-8 animals $30.00
9 or more animals $35.00
�Renewal
PLEASE COMPLETE ALL OUESTIONS New Application
E-MAIL , � l�rnc�.
� NAME I�LI�1�s ��y J"�� HOME TE .N ' � ✓ �
�D�ss .�r�g �'�n� �� �l��-aa�� �t��`�`th.-� c��7�
� MAILING ADDRESS(IF DIFFERENT) ��� � .t��S �`o s__���r� �"lJf�. ��X 15����
EMERGENCY CONTACT(NAMF./TPHONE#) /YI g�`�,�t✓ r'��j�H�► (�����''���`j
VETERINARIAN(NAMEJPHONE#)�1�r f��rV�' (���r�.. ���'G��J�o��,vs7i�i
TOTAL NUMBER OF ANIMALS �f-1
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIMA.LS
� WITHOUT PRIOR PERMISSIUN OF THE HEALTH DEPART NTf��
; 'a�� ���d �
PLEASE LIST EACH SWINEiSHEEP/GOAT SEPAB��d�I��rJ � �
ANIMAL NAIVIE(IF APPLICABLE)
BREED �/ .�1r' 1'
#YEARS OWNED ,�c
COLOR �y �,�
SEX �-,Il Qi
DATE OF RABIES VACCINATION j -
i
DATE OF EEE VACCINATION
; DATE OF OTHER VACCINATIONS
! TYPE OF STABLE/SHELTER ���/ � SIZE OF CORRAL AREA ���� �
i (— W�-CONCRETE,E7'C.) .
; TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN �YZ�/�'�Z� ����C.
TYPE OF FACILITY USED FOR MANURE STORAGE G�ih����i�S ,
METHOD OF DISPOSAL OF MANURE �A"�����"�1�^� �'A�rL�' HOW OF'TEN lJ�liL'J����
IS CORRALJPEN AREA ENCLOSED BY FENCING? YE�(,pd� TYPE OF FENCING �$�� � ��
OTI�R FARM ANIARALS MAINTAINED AT PREMISES? YF,�_v NO
(PLEASE NOTE: POULTRY,HORSES,PONIES, DONKIES REQUIRE SEPAR4TE 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 Yarmouth taxes and liens must be paid prior to renewal or issu ce of your permits.
Please check appropriately if paid: Yes No n/ �
SIGNATURE DATE
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1Nanna!N Gesar Dy1N
PO Box 908/48 Lombard Ave
West Barnstable, MA 02668 US
dr mcesar�a yahoo.com
Invoice
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; S11.L?O �H1P TO llVYQ1�E# 76847
i Taylor- Bray Farm Goats, Donkeys, Cow, Steer DATF 07/31/2016
P.O. Box 66 Sheep DUE�ATE 07/31/2016
� Yarmouthport, MA 02675 108 Bray Farm Rd. TERMS Due on receipt
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SH1P DATE
07/31/2016`
ACTIVITY QTY Hi1 i t r";��it3�y"i
i �
� Fam1 Cal�On Cape 1 70.00 70.00
Farm Call
' 11AeEiiea�ionYaec�nes:Ra�i1 12 18.00 216.00
� Rabies Large Animal-2 goats, 6 sheep,2 donkeys, 2 catttle
i
; 1�Aedtea�Yaec�ne�1NN 8�EWr 2 45.00 90.00
; West Nile Virus &EWT
�' 11Ae�[GYaeCu�e�Cl?!f 8 12.00 96.00
CDlT-Clost T& D,Tetanus Vaccine(sheep&goat)
1'tocedute�I[im�eet 2 70.00 140.00
Trim Feet
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� BALANCE DUE
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