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� °� r� TOWN OF YARMOUZ����� � :: :,�
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= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451 -
MATTACNEESE
�'° Telephone(508)398-2231,ext. 1241 REC
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F�(508) 760-3472
MAR� 3'0 2017 ��
APPLICATION FOR OPERATION- 2017 HEALTH DEPT.
POULTRY
PLEASE COMPLETE ALL QUESTIONS - 1�
E-MAIL �rnq _1��CY�2��P Q QO�-CC�YI
NAME C, HOME TE No �6��3�� - 4 P�{9
LOCATION ADDRESS �- (�1 t�le R.� � • �l t"�'1 Q�T"I A 02,��0�
MAILING ADDRESS(IF DIFFERENT)
NUMBER OF FOWL TQ NUMBER OF PENS/COOPS ( NUMBER OF ROOSTERS �
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL :
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER (J.�c7UC� SIZE OF YARD/PEN AREA -5x O e`^'I"
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS � ? WATER TROUGHS 2 �?
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN �/!1
TYPE OF FACILITY USED FOR MANURE STORAGE (�{,�/'Yt p / � �f✓1
METHOD OF DISPOSAL OF MANURE �t,,)�''"�Q � HOW OFTEN ' � / o� �
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? �U(1 W I re�+
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 Yannouth taYes and liens must be paid prior to renewal or issuance of your permits.
Please check appropriately if paid: Yes ;,� No
SIGNATURE DATE ,� •�O' I�
THE FULL FOULTRY COUNT IS NOT TO EXCEED TAE AMOUNT OF PRIOR YEAR'S TOTAL. '
FEES: X POLTLTRY: 1-9 chickens �30.00
10 or more Chickens 40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
�/ NO ROOSTER
TOTAL DUE: $__�B •�O�
� N� "Raos-�.S
12/12/16
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