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� °� TO WN OF YARMOUTH Boardof
i � _ .._ Health
w 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHLJSETTS 02664-24451 . Health
� '�� Telephone(508)398-2231,ext. 1241
� Fax(508) 760-3472 . l�ivisinn
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APPLICATION FOR OPERATION -2015 ---=- ,_, .___._.
POULTRY
PLEASE COMPLETE ALL QUESTIONS
E-MAIL/�G!���/� c#����C���S"�',i�et
NAME �c:c,C,/[�r- ,(�I'c:.0 �'L�Li HOME TEL.NO.��v-3 g5-�'�7
LOCATION ADDRESS ���' ���-/ t'CE-(�i�( I`GY• lU� ; ���"�(c�C%7�!1-Ol-'f /(� I� G Z;��7 S
MAILING ADDRESS(IF DIFFERENT) J� U, ��K ��
1
NUMBER OF FOWL ��- NUMBER OP PENS!COOPS r NUMBER OF ROG�S'TERS d
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER �ti�O� G�%/C�/i c=/'�f� ��v r%� SIZE OF YARD/PEN AREA /�% X ��
( OOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS � WATER TROUGHS I
TYPE OF STORAGE FACIL,ITY USED FOR FEED/GRAIN �J'f L'� ►c� -FE=�Y�-r i ✓1 �'ao� i-'�-
TYPE OF FACILITY USED FOR MANURE STORAGE_C�M�P���
METHOD OF DISPOSAL OF MANURE G}'Cc,�c{��Gf�f�`� `tG�� HOW OFTEN O/1 �I'ClV1G�
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? V 1 VI U� Cc�Ci,�� f'1�?X �t (��
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 prior to renewal or issuance of your permits. ���
Please check appropriately if paid: Yes No " -
�/J/�G '�
SIGNATURE i� /V � C.-� DATE ti�U- � I� Lv��
THE FULL POULTRY COUNT 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
TOTAL DUE: $ lnll�t VL""l� �� � 2� C�}��c��s� �R�o S7�-
11/03/14