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� TOWN OF YARMOUT
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= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-2 51 �'�` � �'�'�
'�"°°'' Telephone(508)398-2231,ext. 1241 Health
. Fax(508) 760-3472 ��������
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APPLICATION FOR OPERATION -2017
POULTRY N�ALTH DEPT.
PLEASE COMPLETE ALL QUESTIONS
E-MAIL J�Ai ow.o a L7�ly��'.y► ,l.L�+1.
NAME �i�9�t t �j�/Q/rj�p UL-/ HOME TEL.NO. S�g-�'8 j-�7 q 1
LOCATION ADDRESS $ Q/ /,Jcs! ya�p�j1�j ,� ����j ��
MAILING ADDRESS(IF DIFFERENT)
NUMBER OF FOWL NUMBER OF PENS/COOPS f NUMBER OF ROOSTERS G
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER /���,� SIZE OF YARD/PEN AREA �o X/ G
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS � WATER TROUGHS !
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN �`i��
TYPE OF FACILITY USED FOR MANURE STORAGE USCt� ir� Q�t�r y• '
METHOD OF DISPOSAL OF MANURE Li c�a HOW OFTEN �'2 i�fs ' ,���/1 '
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? C�iCKc..- i/.A�
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(/ 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. '
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Town of Yannouth taxes and liens must be paid prior to renewal or issuance of your permits. �
Please check appropriately if paid: Yes�� No
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SIGNATURE DATE l'-/S-/� �
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THE FULL OULTRY COU IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: �/ POULTRY: 1-9 chickens $30.00 �
10 or more Chickens $40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS) !
�NO ROOSTER '
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TOTAL DUE: $ c3���O
12/12/16
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