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� � - Health
= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-2445 " ,'�� - 0 �014
q..o a Telephone(508)398-2231, ext. 1241 Health
Fax(508)760-3472 H � "�EPT.
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APPLICATION FOR OPERATION -2014 ��T�v��
SHEEP/GOATS --' FEE: 1-8 animals $30.00
� 9 or more animals $35.00
� � '�'��i� � �`Renewal �
PLEASE COMPLETE ALL QUESTIONS r� . £ �'� ' New Application
E-MAIL�r4., o� C�m v e,�v.Q�u� .VU�t"
NAME �, ��'cw-n�n, HOME TEL.NO.� S CX 3�a�Yll ( � ��y'QQ�j-
ADDRESS 1 $ �t�1 N�c t�� L.L�ws�_ �0�(�t3'� WL�1- 0 z-(o�S a!'o 3�
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EMERGENCY CONTACT(NAME/PHONE#) S �,..—
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VETERINARIAN(NAME/PHONE#) ��,�.A 2.�N� C�'�c,�o '�a� ��o o`� -��4�O
TOTAL NUMBER OF AriIMALS
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIMALS
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
PLEASE LIST EACH SWINE/SHEEP/GOAT SEPARATELY:
ANIMAL NAME(IF APPLICABLE) S /Z ; J��� R`� 8...
BREED �.1. .JW RJ� F �� N •��f�'�
#YEARS OWNED
COLOR K}N t,�h�f a�✓�!S��c K tJh•
SEX M-
DATE OF RABIES VACCINATION ao f3 �Ot3 ���
DATE OF EEE VACCINATION 1 � r� �< L,
DATE OF OTHER VACCINATIONS � .� � �< <,
TYPE OF STABLE/SHELTER �t�(7D SIZE OF CORRAL AREA �a� � , �
(WOOD,CONCRETE,ETC.)
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN �,�J b D� �-i N l M�-�-L C o/�f9J'VV-��l'
_------ ----- -------------- ---- -_
- --- _- ---- - ----___ _
_ _ _ _ _
TYPE OF FACILITY USED FOR MANURE STORAGE ��� � N
METHOD OF DISPOSAL OF MANURE pnn.,(7�, `1� HOW OFTEN l�� �PG,� )ca
IS CORRAL/PEN AREA ENCLOSED BY FENCING? YE�NO TYPE OF FENCIN G� � f _SL
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YF,�_ NO
(PLEASE NOTE: POULTRY, HORSES, PONIES, DONKIES REQUIRE SEPARATE LICENSURE.)
IF NEW APPLICATION,PLEASE ATTACH A PY OF PLOT PLAN SHOWING LOT LINES AND LOCATION OF STABLE,
�, PEN, ETC., AND ALL ENCLOSURES. ALS A WRITTEN LETTER OR STATEMENT, SIGNED BY ALL ABUTTERS TO
PROPERTY.
Town of Yarmouth taxes and liens must be pa' prior to renewal or issuance of your permits.
Please check appropriately if paid: Yes No
SIGNATU
' i DATE �� � � �
10/08/13