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TOWN OYARMOUTH J
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Health
HEALTH DLPT.
1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-2z-45-1, Health
MA EESE
%%MO" „1 Telephone(508)398-2231, ext. 1241
Fax(508) 760-3472 Dw" n
/4101 1
APPLICATION FOR OPERATION - 2019
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAIL DU JY\ ? rY r q/te ,i'Ie1-
NAME c)6i(� 7-1-0I DV (Y1 HOME TEL.NO.SOS -.36 aO
STABLE ADDRESS I S M LS in mer S-F- 4oic m( Q "Tort Oak-TS-
MAILING
ak`j S-
MAILING ADDRESS(IF DIFFERENT) (X a j 1 Lfa Y rn o u4h `�rro r k al Pr a 15-
EMERGENCY
SEMERGENCY CONTACT(NAME/PHONE#) SG - ai L1 7 -. Co o
VETERINARIAN(NAME/PHONE#) hi r1 0I1 5o Se-- a LI ? - 7 (U / tD
TOTAL NUMBER OF HORSES/PONIES ) TOTAL NUMBER OF STALLS T3
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) 1^r r= L 4-
BREED (} - ni Ct/1
YEAR ACQUIRED I Q' q C
COLOR M
SEX
DATE OF RABIES VACCINATION and-c op?
DATE OF EEE VACCINATION C4i
DATE OF OTHER VACCINATIONS( o((.h ,2a/
TYPE OF STABLE/SHELTER WOOD SIZE OF CORRAL AREA 30 )C 30
(WOOD,CONCRETE,ETC.)
NUMBER OF HOSE BIB WATER OUTLETS DRAINS WATER TROUGHS (')y)f
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN G--r- S
TYPE OF FACILITY USED FOR MANURE STORAGE (}l an a rt. Ul e' a r pa,- de n S
METHOD OF MANURE DISPOSAL mai, u ed ' l (',.:., r dt'( FREQUENCY
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? U"f(,,S--f Q
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO
(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 prjor to renewal or issuance of your permits.
Please check appropriately if paid: Yes No
SIGNATURE R( ,j„1., S -0\1- rr DATE I& 3
FEES: STABLE& 1 HORSE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ 35-00
11/07/18 .B !16.ED- oN �0/g