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TOWN OF YARMOUTH
Board of
Health
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451 Health
Telephone (508) 398-2231, ext. 1241
Division
Fax (508) 760-3472
APPLICATION FOR OPERATION - 2012
POULTRY IF A
O
PLEASE COMPLETE ALL QUESTIONS
NAME
LOCATION ADDRESS
_HOME TEL. NO.,'`{� J�S�
TA R TT TTTr A 77T1P ncc irr. �r�Fcn rr�rml
NUMBER OF FOWL t✓` NUMBER OF PENS/COOPS 2— NUMBER OF ROOSTERS O
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 (Zk l Z InJ 16. J hj
` (WOOD, CONCRETE, ETC.)
NUMBER OF WATER OUTLETS MIA WATER TROUGHS Z
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN MAtlCQ�C
TYPE OF FACILITY USED FOR MANURE STORAGE COM? -T �, r
METHOD OF DISPOSAL OF MANURE C� QQJ ' �q� t ,, r,�,� HOW (O�FT,E(N� � -fi( Q. (V
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? OW (1�` W le— P4�� � �1,( C "C l W /Ye
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
SIGNATURE
DATE
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: Ne POULTRY: l chicke s $30.00
10 or more Chickens $40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE: $ 0,0(3
12/08/11