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LOCATION ADDRE
MAILING ADDRE,B",
NUMBER OF FO/(Y�VL"
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TOWN OF YARMOUTH Board of
_ Health
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451 Telephone (508) 398-2231, ext. 1241 Health
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Fax (508) 760-3472
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APPLICATION FOR OPERATION - 2012 JAN P1 3 2012
POULTRY
:HEALTH DEP1.
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HOME TEL. NO.. -) U AS
OF PENS/COOPS MBER OF ROOSTERS
PLEASE NOTE PL ADO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER X) A C) SIZE OF YARD/PEN AREA 4—
( OOD, CONCRETE, ETC.)
NUMBER OF WATER OUTLETS r' WATER TROUGHS
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN(
TYPE OF FACILITY USED FOR MANURE STORAGE
METHOD OF DISPOSAL OF MANURE
PEN AREA ENCLOSED BY WHAT TYPE OF
RENEWAL
NEW APPLICATION - IF NEW
LINES A
Town of Yarmouth taxes and liens must be
Please check appropriately if paid: Ye
SIGNATURE
OFTEN
IT PLAN SHOWING LOT
ENCLOSURES. ALSO, A
I'TERS TO PROPERTY.
THE FULL POULTRYCOUNT 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: $ .3D. 0 0
12/08/11