HomeMy WebLinkAboutOld Application and Notes NOV 0 /Z019
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r 4•4 ti. TOWN OF YARMOUTH Board of
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%"4--i1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451 -
Telephone(508)398-2231,ext. 1241 JAN U '
Fax(508)760-3472rvicinn
HEN.TH DEPT.
APPLICATION FOR OPERATION-2017
STABLE °
PLEASE COMPLETE ALLUESTIONS E-MAIL",--, Ce,„6`,,,� A
NAME ; l. 714-4,.. HOME TEL.NO. -$9-�-6`6 7 1
STABLE ADDRESS ( 9- -'�� `�uti--C �'o...''vim.' . - e Z.G-Z'3
MAILING ADDRESS(IF DIFFERENT) L-? > ''
EMERGENCY CONTACT(NAME/PHONE#) V Fc%1 ' 37�L C0 7v 3
VETERINARIAN(NAME/PHONE#) 1i 17. 6101.1-r-- 0k '626-4- ree_ V9 1"
TOTAL NUMBER OF HORSES/PONIES Ell /P TOTAL NUMBER OF STALLS 5 o"' 2.-i 4".
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)
BREED )
#YEARS OWNED ✓ /
i
COLOR ,i,
SEX ,'
4
DATE OF RABIES VACCINATION
DATE OF EEE VACCINATION
DATE OF OTHER VACCINATIONS
TYPE OF STABLE/SHELTERAfftri SIZE OF CORRAL AREA
(WC E,ETC.)
NUMBER OF HOSE BIB WATER OUTLETS DRAINS WATER TROUGHS 6
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN atAVL —
TYPE OF FACILITY USED FOR MANURE STORAGE Ci(IY►tirtt
METHOD OF MANURE DISPOSAL �.r FREQUENCY✓ d kr,
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? V POet,
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO
(PLEASF�I�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 pai or to renewal or issuance of your permits.
Please check appropria paid: Yes No
SIGNATURE DATE / ' / 1 1 / '
'
FEES: ST BLE& 1 RSE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ 60 O.0 U
12/12/16
8460)ON ZO 1,6