HomeMy WebLinkAboutApplication `-/Jf-Q6/ d O-IfS-/S-/ZYs-d q
` TOWN OF YARMOUTH _ 0I a``tr2
—"'E V 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-2A451 J, 04- m
Telephone(508)398-2231, ext. 1241
p Division
Fax(508)760-3472 FLF -,; `DT
APPLICATION FOR OPERATION - 2019 ,*(x
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAIL oc \\QmS vcMe b
NAME cc.7C C( N,t\\o . HOME TEL.NO. CSS A3.1 - V
STABLE ADDRESS k\ c c c . - p,crc•N\V\"c'SV4 C'S c(Q(p\
MAILING ADDRESS(IF DIFFERENT)
EMERGENCY CONTACT(NAME/PHONE#1 cbck_c tf\\ozs‘ilc-o CN% (p
VETERINARIAN(NAME/PHONE#)cc\k-v.„C �� � - 'O D k-km
TOTAL NUMBER OF HORSES/PONIES Co TOTAL NUMBER OF STALLS
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIMALS
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT. /
PLEASE LIST EACH HORSE/PONY/DONKEY/COW SEPARATELY: SAJZtry✓h
ANIMAL NAME(IF APPLICABLE) (-xns&\ c ✓ c ✓ n�� ✓ QRS\ens Xe c ✓ Va:
BREED ce..\Aic N`c`m. \ c' '\cS
YEAR ACQUIRED \Q c •fit (0
COLOR tXX.Y,3stISINbMCO% CSO\c\S\( ¶ cc \ Vt t k CO
SEX Cle_t�� 4kSt \ `ice '"C °�rC\C`c'-Ne ; \\c% �S
DATE OF RABIES VACCINATION 5..k% 5-\ i`j\�
DATE OF EEE VACCINATION 5,.\� \% t-\ °S-S� S\ Io4
DATE OF OTHER VACCINATIONS 5_ is\czaz, -\% t$ (n—`Z
TYPE OF STABLE/SHELTER S - mem n► SIZE OF CORRAL AREA
(WOOI,CONC TE,ET .
NUMBER OF HOSE BIB WATER OUTLETS \Q DRAINS WATER TROUGHS \a
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN C''k c,\ 4c `5 � \k6k
TYPE OF FACILITY USED FOR MANURE STORAGE \ 5-A ('\S
METHOD OF MANURE DISPOSALVs `FREQUENCY \
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING?
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NOS
(PLEASE NOTE: POULTRY, SWINE, SHEEP, CATTLE, GOATS REQUIRE SEPARATE LICENSURE.)
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 \_ \q
FEES: STABLE& 1 H SE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ (O.00
11/07/18
* 66SED dA) .2018