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HomeMy WebLinkAboutApplication IR-00616.0 HS-15-4 V46:4'4 •.,�m-..,,� t'""^; e. TOWN OF YARMOUTI ..D ��, ����ea1'tl �`_ "�i = 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS (2664-24451 - � �, ealt� -__� ;,:' Telephone(508)398-2231,ext. 1241 JAS 0 9 L01 . . Fax(508) 760-3472 Air HEALTH DEPT. APPLICATION FOR OPERATION-2019 STABLE PLEASE COMPLETE ALL QUESTIONS E-MAIL VA\Ducs;ao,.SC.�r arena,I. Cow, NAME ck r,ie Q,1,60V Tr. HOME TEL.NO. SOBS • 'y i •Lis.t r,S STABLE ADDRESS !bO\10 K.)( X2a. •' ,9, 400 yn M--, 014,c D-&73 MAILING ADDRESS(IF DIFFERENT) 4 3 g 1,....al .. 12r1Yr� ( J-.9 1 Ano,,A\ t d - 0)‘11/:), EMERGENCY CONTACT(NAME/PHONE#) elu'I,L1thAr 1&)C.1`.L ‘CA;4 VETERINARIAN(NAME/PHONE#) Afirk V1\O VIA 'Or, 1,..e Al tei 1•.. TOTAL NUMBER OF HORSES/PONIES a, TOTAL NUMBER OF STALLS 3 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) t.,1.4 A •per r5 (3uAtA11,901 BREED P,nl-ti'#,'-A)7 flw,,,4t Istamse YEAR ACQUIRED COLOR 81114,14-, WhT A SEX `11YtiA'Ae_ Coe,I� DATE OF RABIES VACCINATION $1, cl$ $1 .2 o IS" DATE OF EEE VACCINATION $1 a p I E $I a m 1 f DATE OF OTHER VACCINATIONS TYPE OF STABLE/SHELTER VO ply a SIZE OF CORRAL AREA 400 .3© b:3O (WOOD,CONCRETE,ETC.) Cf'010 NUMBER OF HOSE BIB WATER OUTLETS dl. DRAINS WATER TROUGHS (134(k e., TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN t TYPE OF FACILITY USED FOR MANURE STORAGE T ill trfP(5 i- I�GGGYLek_5 METHOD OF MANURE DISPOSAL__! ' Q {. -_ CI_LJe u,waj FREQUENCY CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? tjletivN U 14k i- w0oA OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO tZ (PLEAE 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 paidpfior to renewal or issuance of your permits. Please check appropriately if paid: Yes V No SIGNATU & (.-CfAblet& L 04 fe,c a/45.620DATE t t,` i e FEES: STABLE& I HORSE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ 40.'0 0 11,07,18 ej^^5 "N 2O I V