HomeMy WebLinkAboutApplication �'1—D I�y 5o ti-P--1—)—3(0(O —OZ /\
..'....-‘ TOWN OF YARMOUTH Board of
Health
1041
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, " 11� 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-.L44 ;r—:, ,ja.T\t�,
MATiY1CHEE8E. vALJ LS ',.�I�l�
ono Telephone(508)398-2231,ext. 1241 Division
;: Fax(508) 760-3472 JAN [ 2 209
APPLICATION FOR OPERATION - 2019 '' IEALTH UJ=P .na.�
POULTRY
PLEASE COMPLETE ALL QUESTIONS
E-MAIL
NAME /ice./f4/J _ cctleiA/
HOME TEL.NO. /1 *. 41 --9Y03,'.
LOCATION , DRESS /5- /!Ll Mak S ,01
MAILING ADDRESS(IF DIFFERENT)
NUMBER OF FOWL NUMBER NUMBER OF PENS/COOPS I NUMBER OF ROOSTERS
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT../
TYPE OF SHELTER 00°6 SIZE OF YARD/PEN AREA 2V ( I -
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS �l WATER TROUGHS a
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN ' c I g hLji
TYPE OF FACILITY USED FOR MANURE STORAGE --bi 1 .
METHOD OF DISPOSAL OF MANURE HOW OFTEN /V/ - A.
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? /)/19 11 C -14(.-Z , / I
_ NEWAL
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 paidprior to renewal or issuance of your permits. _..
Please check appfopriately if paid: Yes No
SIGNATURE dit °").4/0 trjeAC-----
DATE
1 if
THE FULL Pt LTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S T AL.
FEES: 4, 41 POULTRY: 1-9 chickens QQ 007
10 or more Chickens b4O UtJ
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE: $ =
11/07/18
/