HomeMy WebLinkAboutApplications � '
�'(?-66� �a�SG-���-3oZ3 ��_,. _ _ _ . ���
� r 2017 �� f
TOWN OF YARMOUTH ����Q
� � Health � E s
= 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHLJSETTS 02664-24451� �"`Health �����""� �
'�.�p Telephone(508}398-2231,ext. 1241 '
l�ivi�i�n C
Fax(508)760-3472 ��.N , ;
APPLICATION FOR OPERATION-2017 ' "�O
� SHEEP/GOATS FEE: 1-8 im 0.'�"�
9 or more animals $35.00
Renewal �
PLEASE COMPLETE ALL QUESTIONS New A lication
E-MAIL C..�� �
NAME�((�Q � `� HOME TEL.NO. '
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. -���sS ''�c�h \� �V:\C�� ��5�� �Q���1�"L1 �► � � V_ _ _ __� ,
i
MAILING ADDRESS(IF DIFFERENT) i
EMERGENCY CONTACT(NAME/PHONE#) ��(� ���(����� ������
VETERINARIAN(NAME/PHONE#) `���C1G ��`�„� ' �YJ� �� � �e��
TOTAL NUMBER OF ANIMALS � I��I
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) ;
BREED i
#YEARS OWNED �
COLOR
SEX
DATE OF RABIES VACCINATION ..�
DATE OF EEE VACCINATION .�
DATE OF OTHER VACCINATIONS `_� �
,
TYPE OF STABLE/SHELTER�-�(�f,�t,- SIZE OF CORRAL AREA �dp X S4
'i (WOOD,CONCRETE,ETC.)
! TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN�, G� �[`LiCCF.��:r vJ�'R�i(�S
�
TYPE OF FACILITY USED FOR MANURE STORAGE �Q�S
METHOD OF DISPOSAL OF MANURE ���\C.,- HOW OFTEN 1� l���G
IS CORRAL/PEN AREA ENCLOSED BY FENCING? YE�NO TYPE OF FENCING�l� Q� P.\�C�l`K�
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YF"� NO
(PLEASE 1VOTE: POULTRY,HORSES,PONIES,DONKIES REQUIRE SEPARATE LICENSURE.)
� IF NEW APPLICATION, PLEASE ATTACH A COPY OF PLOT PLAN SHOWING �.OT 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 t�es and liens must be paid prior to renewal or issuance of your pernuts.
Please check appropriately if paid: Yes No
SIGNATURE DATE �-a(e•�
12/12!16
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