HomeMy WebLinkAboutApplication $15-003 0044-3-642.5 0-0�{
TOWN OF YARMOUTH Board of
%21971146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451 Health
Telephone(508)398-2231, ext. 1241 DEC 2 8 30,18,-,= "'' Fax(508) 760-3472
HEALTH nEP,
APPLICATION FOR OPERATION- 2019 lir
STABLE Cialk
PLEASE COMPLETE ALL QUESTIONS E-MAIL
NAME $Tllv f.'.) /3, .70 leAi a ^I HOME TEL.NO.-.)-v '39I'7 5 Z.
STABLE ADDRESS 77S>iiZ4-6aflNZ /L.v,J-,J S'7 ct( f7'l4 , A'1nSS
MAILING ADDRESS(IF DIFFERENT) /VL4 R Mil)"4- `^ C s /Hz, .P Y^?
EMERGENCY CONTACT(NAME/PHONE#1 5-0 F 3 ir 7 7 i
VETERINARIAN(NAME/PHONE#) f'2'$ .3`( Z. 3 L`/G
TOTAL NUMBER OF HORSES/PONIES / TOTAL NUMBER OF STALLS y Y o447
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) 'rye,r�„� ,, 3 ics
BREED d 4 2 .9
YEAR ACQUIRED a i ff
COLOR . -+(
SEX ,1 1-i .�
DATE OF RABIES VACCINATION
DATE OF EEE VACCINATION ( 2-5;
DATE OF OTHER VACCINATIONS u t W
TYPE OF STABLE/SHELTER, 4 it r/- L ,iii.✓ SIZE OF CORRAL AREA 76s/So j n a o0
(WOOD,CONCRETE,ETC.)
NUMBER OF HOSE BIB WATER OUTLETS j DRAINS 6/1 o" O WATER TROUGHSgac, ti' -'714
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN 7°A C d",
TYPE OF FACILITY USED FOR MANURE STORAGE 0 2 r J
METHOD OF MANURE DISPOSAL Y, n-e /eR ,✓9 FREQUENCY /a zi if r
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? a ar n /Tlf /e G Z. 7 -I
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO V
(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 O No
SIGNATURE - -- -"" DATE /z4-r///e
FEES: STABLE& 1 HO' ► $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ 60.DO
11/07/18
4r 84S div 2418