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°� r TOWN OF YARMOUTH Bo�-dof �
� � Health
= 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHLJSETTS 02664-24451
o.,�� Telephone(508)398-2231 ex�241��, �� e Health
Fax(508)76�U-�3�t t,` � � �" � G3L5�C�� o
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APPLICATION FOR OPERATION -2015
POULTRY HEALTH DEPT.
PLEASE COMPLETE ALL QUESTIONS t . ���p� � ( (�Z��
E-MAIL K.
NAME ��� : � .;C,�� �,�� "�`., � � ��� � CC��'iil G.J� .v���1-- ��
HOME TEL.NO. �j��i�1�, C�l0 3 I
LOCATIONADDRESS �"Z L UU�. �Cs� � � � Z�D�-3
MAILING ADDRESS(IF DIFFERENT) °— —
_NUMBER OF FOWL � - NUMBER-OF PENS/COOPS I NUMBER OF ROOSTERS Q
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER �LJ O�. SIZE OF YARD/PEN AREA �t X � 1� W
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS � WATER TROUGHS 1
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN `G��C G 'e-
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TYPE OF FACILITY USED FOR MANURE STORAGE I�1'
METHOD OF DISPOSAL OF MANURE HOW OFTEN (�C we��
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PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? t,��l � "L��. W�r ��
�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 Yannouth taxes and liens must be paid or to renewal or issuance of your permits.
Please cheel�appropriateiy if paid: Yes� No ��
,.''' y,:'"' �� � ''>
SIGNATURE �` �� DATE I2-�Z� I
THE FULL P ULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEESc � POULTRY: 1-9 chickens �
10 or more Chickens �4U•uu
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE:$ 3�•OO
( 11/03/14
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