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� ` TOWN OF YARMOUTH Boazdof
� � Health
= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451 -
�a Telephone(508)398-2231,ext. 1241 Health
Fax(508)760-3472 ����-�����
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APPLICATION FOR OPEI�4'I'��OAT=�20�5 � �
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POULTRY `
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PLEASE COMPLETE ALL OUESTIONS `� - ` '
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NAME �0 � �� HOME TEL.NO. ��°�O� ��
' LOCATION ADDRESS
� MAILING ADDRESS(IF D FERENT) /
NUMBER OF FOWL NUMBER OF PENS/COOPS NiJMBER OF ROOSTERS
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT. � �;
TYPE OF SHELTER �(I(�� SIZE OF YARD/PEN AREA �� J S
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS � WATER TROUGHS
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN �✓ � — ,� �
TYPE OF FACILITY USED FOR MANURE STORAGE�a��l' �r 4' r
i METHOD OF DISPOSAL OF MANURE� /� � i n C HOW OFTEN /'1 i►
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? (��r (i �� G /� /
�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 pai pnor to renewal or issuance of your permits.
Please check appropriatel ' paid: Yes� No
SIGNA ' � DATE � Z(��7/
THE FULL LTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: POULTRY: 1-9 chickens $30:
10 or more Chickens 0
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE: $
U'P �t-u (, c�n�c�lk.r�g
11/03/14
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