HomeMy WebLinkAboutApplication IF-Do? e,6ci-s --ls-210a-G-04
. °� TOWN OF YARMOUTH Board of
IAV e% r.,;•,i-14
iz _;4,(i 'i i I 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451
W SE EE
r° Telephone(508)398-2231, ext. 1241 APR a' ,19
,. ; Fax(508) 760-3472
HEALTH DEPT
APPLICATION FOR OPERATION - 2019
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAIL 5.6 Gia C( 3 17ae'wi5i,Co"
NAME dale ACR eS HOME TEL. NO.50%,W SSS
STABLE ADDRESS 1 7 ON el /\J, m h //\)
MAILING ADDRESS(IF DIFFERENT) C
EMERGENCY CONTACT(NAME/PHONE#1 14 US)E- 7 7 i4d.o LR 71n1i J 001 So g? 7�"//�
i J
VETERINARIAN(NAME/PHONE#) ai1 A)E 5d ca ( ED-73 _
TOTAL NUMBER OF HORSES/PONIES TOTAL NUMBER OF STALLS S
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:
ANIMAL NAME(IF APPLICABLE) 4 j pvv,€,2 z"'.Aki. f it?NA; 55`-i DiA£iel-O
BREED -A194-44. APJ-I:A }4-P44A — A Pi-I14
YEAR ACQUIRED 001)g 1,v1 8(I/( 0017 c912J`�
COLOR , (- W\J ReM 6L1 -- 'w.H rrc_ Sfq-b w--1
SEX (�
DATE OF RABIES VACCINATION 7/ / -l1 /1 7// 7,
DATE OF EEE VACCINATION 1 .+ �i p /9
DATE OF OTHER VACCINATIONS lf +t h 1 n
TYPE OF STABLE/SHELTER (N (2017-9 C,0 M SIZE OF CORRAL AREA 156 N. sb
(WOOD,CONCRETE,ETA.)
NUMBER OF HOSE BIB WATER OUTLETS DRAINS WATER TROUGHS 3
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN 1Z+Q 5
TYPE OF FACILITY USED FOR MANURE STORAGE W'' -- zuct
METHOD OF MANURE DISPOSAL l& --T7 FREQUENCY a X vJ K
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? F�j" �coQ,1 C
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO x'
(PLEASE NOTE: POULTRY, SWINE, SHEEP, CATTLE, GOATS REQUIRE SEPARATE LICENSURE.)
X 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
SIGNATURLC � -1--/
.? cre (�/4'1_.,-�--�_ DATE ' /-f ei
FEES: STABLE& 1 HORSE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ 55-6.00
11/07/18
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