HomeMy WebLinkAboutApplication 4-020-co //E.041—i 7-3855—EZ3
Cor
` - TOWN OF YARMOUTHBoard of
_ Health
Health
�� 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451
Telephone(508)398-2231,ext. 1241
Fax(508)760-3472 -_ Division
APPLICATION FOR OPERATION-2020 JAN 10 2019
POULTR , . ,
- kl„ y NHEALTH DEPT.
PLEASE COMPLETE ALL QUESTIONS
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NAME N lei'�,�,�,4`e ,Sumpt( HOME TEL.NO 1r 9 , q COMLOCATION ADDRESS L Pal ne ed S. I ar yv
MAILING ADDRESS(IF DIFFERENT)
NUMBER OF FOWL /O# NUMBER OF PENS/COOPS 1 NUMBER OF ROOSTERS
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER (J"004 (�
SIZE OF YARD/PEN AREA �'X�Z1 roil W i cop
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS / WATER TROUGHS (
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN Pt tuAel in(}
TYPE OF FACILITY USED FOR MANURE STORAGE jiftiz h b”,/dump d( qa/' 11 s 6 I ( .
METHOD OF DISPOSAL OF MANURE rider)/n 61 4 Ihnt .. HOW OFTEN —2., k Pa c°
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? hard kJ4 the c/c
I
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
� DATE �° 944
THE FULL POULTRY COUNT IS NOT TO E D THE AMOUNT OF PRIM YEAR'S TOTAL.
FEES: 'POULTRY. • ' 0.00
f I or more Chickens ,4 i.•i
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE:$ Lb.00
12/30/19