HomeMy WebLinkAboutApplication ,02,0-oo37baH545--tvie-
°�..... TOWN OF YARMOUTH,
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Health
: ! 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-'445 MN 1 g
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Telephone(508)398-2231,ext. 1241 n`Q`
Fax(508)760-3472 HEALTI--Pbr '
APPLICATION FOR OPERATION-2020 ti /r ; iii`ci
STABLE ,
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PLEASE COMPLETE ALL QUESTIONS E-MAI141WJ1G+'c t.11°Q '
NAME �� _ �� y��� HOME TEL.NO.
STABLE ADDRESS W:1 bAI\N` "\C`'C C`13 VC .\`- �(`y\ CO1i1
MAILING ADDRESS(IF DIFFERENT) �7�1 ` , "�
EMERGENCY CONTACT(NAME/PHONE#1 . 3ftc`c \ r1 5C9T3'1 ` .;; L
VETERINARIAN(NAME/PHONE#)cC\ T1(k C 5(%•; \ k-i c \ %
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TOTAL NUMBER OF HORSES/PONIES (p TOTAL NUMBER OF STALLS V i v
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIMALS
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
PLEASE LIST EACH HORSE/PONY/DONKEX/COW SEPARA)TL Y: ✓ ✓✓ ✓�
ANIMAL NAME(IF APPLICABLE) 1po✓/ '�
BREED ����r �"ZV\� ��`tl�:N t`�'I1`�\1'C'� Ct �1 �
YEAR ACQUIRED \��
COLOR '�.Y�CS`f,�c� \O `at-at 'WZ3 `� ' t4
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SEX �ti � qt� q VSr'�� grc` S� �n'S�^sG "i[4 �iS
DATE OF RABIES VACCINATION f,.1V�� Q NC 11C t�A 4Ak1�� I�\iN
DATE OF EEE VACCINATION '
DATE OF OTHER VACCINATIONS pq \q c ..\Q C�"`: (o ��1
TYPE OF STABLE/SHELTER &« ik i SIZE OF CORRAL AREA
(we•-•, • C• TE,ETC.)
NUMBER OF HOSE BIB WATER OUTLETS \C\ DRAINS WATER TROUGHS z,
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN Mg\c,\ 1[3G,crz_\\c-0 4k,9e\`'rt \`&S
TYPE OF FACILITY USED FOR MANURE STORAGE arko` - „ cod
METHOD OF MA1 REDISPOSAL 63\t\\ k`Jvi-"\ FREQUENCY \)( tt`C
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? Lar ,` �\tc_\V:\.C Wk.'Er
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 taxes and liens must be paid prior to renewal or issuance of your permits.
Please check appropriately if paid: Yes'x No
SIGNATURE DATE\\\7 Q
FEES: STA E& 1 RSE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ l:0.00
12/30/19 ZO VI —7 thio