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TOWN OF YARMOUT
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664 -
Telephone (508) 398-2231, ext. 1241
Fax (508) 760-3472
APPLICATION FOR OPERATION - 2017
POULTRY
PLEASE COMPLETE ALL QUESTIONS
NAME
9
REC&NEED
51 MAY Q����Irl
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HEALTH DEPT
E-MAIL � SSS e 4 NO(t5f ,
)HOME 1TEL. NO.
LOCATION ADDRESS k z i✓cLk- l„�1 eft l Il �O-C-4
MAILING ADDRESS (IF DIFFERENT)
NUMBER OF FOWL NUMBER OF PENS/COOPS NUMBER OF ROOSTERS
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR P(E.R�MIS§ION OF THE HEALTH DEPARTMENT.
W
TYPE OF SHELTER 6 � SIZE OF YARD/PEN AREA
(WOOD, CONCRETE, ETC.)
NUMBER OF WATER OUTLETS WATER TROUGHS
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN
TYPE OF FACILITY USED FOR MANURE STORAGE M Q 7Y,
METHOD OF DISPOSAL OF MANURE R, P C1 &C R -r— HOW OFTEN W-. 2 - '
PEN AREA ENCLOSED BY WHAT TYPE OF
RENEWAL
NEW APPLICATION -
n
r i;
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
Please check appropriately if paid: Ye:
SIGNATURE ,
THE FULL PU RY COUNT IS NOT
FEES: POULTRY: 1-9 chickens
10 or more Ch
ROOSTER (NOTE: SPEC
NO ROOSTER
TOTAL DUE: $ .3 d •rjo
12/12/16
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