HomeMy WebLinkAboutApplicationt
:
'• �fs��o3 �a}� ���S! l Z�f
� � � � � � -- -`.. �m,
� � TOWN OF YARMOUT ��;;�,�H�����4
� �
i = 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHLTSETTS 02664-244 1 �,��_H���— -,-�
j ��' Telephone(508)398-2231,ext. 1241 n,�,c;nn
� Fax(508) 760-3472
������
APPLICATION FOR OPERATION-2015 �(GA
STABLE
PLEASE COMPL TE ALL UESTIONS E-1v�,IL
NAME . � l y� . t.U�' ai : � HOME TEL.NO. ��
STABLE ADDRESS (�i/� �'�u���'����
MAILING ADDRESS(IF DIFFERENT) � ���'-� '��
^; ._...._..,
EMERGENCY CONTACT(NAME/PHONE#1 �"i�r� �C�2�� tS�Z��` �`� '�^'� ��l �-�
I VETERINARIAN(NAME/PHONE#) �L'UI`� W r ." 9� i.J�-�'��� �.� �6 I C�
TOTAL NUMBER OF HORSES/PONIES �"' , TOTAL NUMBER,OF STALLS�
, PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIMALS
iWITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
PLEASE LIST EACH HORSE/PONY/DONKEY/COW SEPARATELY:
ANIMAL NAME IF APPLICABLE
� BREED
j #YEARS OWNED
; COLOR �
SEX
DATE OF RABIES VACCINATION
DATE OF EEE VACCINATION
DATE OF OTHER VACCINATIONS
TYPE OF STABLE/SHELTER li(l�fG� �+"-' /'�./��/►"'� SIZE OF CORRAL AREA
(WOOD,CONC ETC.)
NU�VIBER OF HOSE BIB WATER OUTLETS � DRAINS WATER TROUGHS �
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN_�(x/�-
r
TYPE OF FACILITY USED FOR MANURE STORAGE
METHOD OF MANURE DISPOSAL � � - FREQUENCY
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? /�i/4� �bUlrvr.�. / �.. �
O'FHER FARM ANIMALS MAINTAINED AT PREMISES? YES � NO
(PLEASE NOTE.• POULTRY,SWINE, SHEEP, CATTLE, GOATS REQUIRE SEPARATE LICENSURE.)
RENEW
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 pai�or to renewal or issuance of your permits.
Please check appropriately if paid: Yes No
SIGNATURE ` DATE
l�- � - 1
FEES: STABLE 1 HO 30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ (cD.00
I1/03/14
2�1�-�- — (o �}o(LSE�, I PONy