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,....r _ TOWN OF YARMOUTH Board of
Set V. s "ealth✓
lz =-% 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451 MA EESETelephone(\508)398-2231, ext. 1241 dhealth-
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APPLICATION FOR OPERATION -2019
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAIL 19(.1'1w' OW1 ' -Cat'(
NAME M y1,04-132_,01 HOME TEL.
NO e:25 d41 9
STABLE ADDRESS /6.6'13(211 AW/ ...?-7Al' yo4 -4 ' -C'-"""t (
MAILING ADDRESS(IF DIFFERENT) �' is - DO ! 4V-036.477/ /1( (77° JW5
EMERGENCY CONTACT(NAME/PHONE#1 07A711 au* 0_3_525.0-3 ,10-S-174_9=3
VETERINARIAN(NAME/PHONE#) m FiJw4 C� ,j 5d "34 ` ,3k2 --6
TOTAL NUMBER OF HORSES/PONIES #'174 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/CP TELY:
ANIMAL NAME(IF APPLICABLE) 7 i5 "r�-
BREED `5644-t- C L p rr1<T9 1'Yl 'Al r 073A
I D 6
YEAR ACQUIRED � b A�
COLOR Fit6L-� E%�`t ; W� -..-
SEX s �i
& �7
DATE OF RABIES VACCINATION ' Lj14/ (' ae- ;.
DATE OF EEE VACCINATION i/
i--)
J / r
DATE OF OTHER VACCINATIONS ji t,4' ;/04
TYPE OF STABLE/SHELTER C'✓b I� > SIZE OF CORRAL AREA 4 %. 'O4'r A5(
(WOOD,CONCRETE,ETC.)
NUMBER OF HOSE BIB WATER OUTLETS / DRAINS O WATER TROUGHS '''
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN CG a iaro Mi Q 8-(LaCc
TYPE OF FACILITY USED FOR MANURE STORAGE 06-6)f4.,/�
METHOD OF MANURE DISPOSAL�� ,614,4 Bv 619--- FREQUENCY C b67r1V
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? 10342 4- w
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES t/ NO
(PLEA E1 OTE 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 Ai A V 2� IilLk, 4 DATE J i/ gJ J g
FEES: STABLE& 1 ORSE 4110; (+$5.01 each al ditij 1 horse/animal) TOTAL DUE:$ KA I
11/07/18