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� °� �� TOWN OF YARMOUTH Boardof
� � Health
= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHiJSETTS 02664- 445���E���
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Telephone(508)398-2231,ext. 1241
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Fax(508) 760-3472 MAY 01 20��
HEAL DEPT.
APPLICATION FOR OPERATION- 2017 *, :
POULTRY
Yr�.;
PLEASE COMPLETE ALL QUESTIONS '�'�
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NAME �5� � ���0 YJ� �1 HOME EL.NO. ��`�{ r 3 3��o�q a�
LOCATION ADDRESS q �j �.O lJ�� (p�' 1 dl,i('MOV�'I'� I��Y� C7 Z �D� �
MAILING ADDRESS(IF DIFFERENT)
� NUMBFR OF FOWL NUMBF,R OF PENS/CnnPS NiJMBER OF ROOSTERS Q
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE I3EALTH DEPARTMENT.
TYPE OF SHELTER W('Q � SIZE OF YARD/PEN AREA�� S�I, ��
(WOOD,CONCRETE,ETC.) �
NUMBER OF WATER OUTLETS ! WATER TROUGHS �
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN �,e�Q
TYPE OF FACILITY USED FOR MANURE STORAGE GU�np S T
METHOD OF DISPOSAL OF MANURE ���(y���S'� HOW OFTEN � I� l
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? C�I(/I�71 VJ 1 r'E_
V 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 Yarmouth taxes and liens must be paid p�r'.or to renewal or issuance of your permits.
Please check appropriately if paid:- Yes �/ No -
SIGNATURE DATE
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: �POULTRY i-9 chicke $30.00
or more Chickens $40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS) ,
NO ROOSTER
TOTAL DUE: $ �JO�O�
12/12/16