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TOWN OF YARMOUTH Board of
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%_ -=% 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451
°E Telephone(508)398-2231, ext. 1241 MAR U ,,,HM,
Fax(508) 760-3472
HEALTH DEPT.
APPLICATION FOR OPERATION - 2019
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAIL &`l'"' -VL-»r/ 1 yval/t�,It.
NAME ,Ail' pj.yy,9_,/ 1 ,, ) lj.9Mf"TEL.NO. SU�- �3 6 6
STABLE ADDRESS `SI c 1!„VJ Y.?41 1 S rl-'2/ 0 -VII du It” -Sri V14/1 c),) 6 S
MAILING ADDRESS(IF DIFFERENT) , 4,/ Q
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EMERGENCY CONTACT(NAME/PHONE#) '\(kite" 1n
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VETERINARIAN(NAME/PHONE#)
TOTAL NUMBER OF HORSES/PONIES TOTAL NUMBER OF STALLS
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIMALS
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
PLEASE LIST EACH HORSE/PONY/DONKEY/COW SEPARATELY:
ANIMAL NAME(IF APPLICABLE) JA---
(
BREED
YEAR ACQUIRED C
COLOR !r, _ I
SEX �.,/1DATE OF RABIES VACCINATION !i'DATE OF EEE VACCINATION3,Aii\) 71441
i
DATE OF OTHER VACCINATIONS
TYPE OF STABLE/SHELTER SIZE OF CORRAL AREA
(WOOD,CONCRETE,ETC.)
NUMBER OF HOSE BIB WATER OUTLETS DRAINS WATER TROUGHS
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN
TYPE OF FACILITY USED FOR MANURE STORAGE 1
METHOD OF MANURE DISPOSAL FREQUENCY
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING?
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 tax-s and liens must be paid prior to renewal or issuance of your permits.
Please check appropri.tely if paid: Yes No
SIGNATU' 1' 1/ i ,.' •► -Ir- DATE c2 (.;([11
FEES: STABL & 1 HORSE ', 0.00(+$5.00 each additional horse/animal) TOTAL DUE:$
11/07/18
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