HomeMy WebLinkAboutApplication aGC�GOdC�D
�'�� ��OQ (Ol�$-IS-(2Y '�p(AR 23 201�
� r TOWN OF YARMO HDEPT.
� Boar of
Health
1146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664-24451 Health
�• Telephone(508)398-2231,exL 1241
nivici�n
Fax(508}760-3472
APPLICATION FOR OPERATION-2017
STABLE
PLEASE COMPLETE ALL OUESTIONS E-MAIL 1�9�1 G✓• /h�/�(��d�C�N�1��
NAME ZS� ` �h`r7''1 HOME TEL.NO�D�L��a�-�1��
STABLE ADDRESS rl��m �� � � �a�� � �T�
MAILING ADDRESS(IF DIFFERENT) �� � � � � /�
EMERGENCY CONTACT(NAME/PHONE# R � �� "������ 2-7��°�✓
VETERINARIAN(NAME/PHONE#) o•,Ie��iY� ��'L,�/�/J� ��Y7 � �(v p� ���
TOTAL NUMBER OF HORSES/PONIES��_ TOTAL NUMBER OF STALLS
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER 4F A1vIMALS
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
PLEASE LIST EACH HORSE/POIVYIDONK�E�Y/,CQW SEPARATELY: �O F
W �
AIVIMAL NAME IF APPLICABLE
BREED �
#YEARS OWNED
COLOR
SEX
DATE OF RABIES VACCINATION
DATE OF EEE VACCMATION
DATE OF OTHER VACCINATIONS
TYPE OF STABLE/SHELTER I�ls� SIZE OF CORRAL AREA���� �.l7�
(WOOD,CONCRETE,ET .)
NUMBER OF HOSE BIB WATER OUTLETS DRAINS WATER TROUGHS I
TYPE OF STORAGE FACILITY USED FOR FEEDlGRAIN ���-��ZZ�J �R$f e�✓�r�rr.S
TYPE OF FACILITY USED FOR MANURE STORAGE C.��i'J7 AS��
.
METHOD OF MANURE DISPOSAL C'����w�i�-7 �'� FREQUENCY �.���r3
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? L�OCS`� ��R�
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO :
(P1;�iAy�&NOTE: POULTRY,SWINE,SHEEP,CA7TLE, GOATS REQUIRE SEPAR4TE LICENSUR�)
z�RENEWAL
NEW APPLICATION- IF NEW APPLICATION,PLEASE ATTACH A COPY OF PLOT PLAN SHOWING LOT
LWES 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 i� ce of your permits.
Please check appropriately if paid: Yes No �►
SIGNATURE - �� DATE
FEES: STABLE& 1 HORS 0.00(+�5.00 each dirional horselanimal) TUTAL DUE:$
IZ/17I16