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O F YARMOUTH Board of
Health
1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 0266.4-24451 -
Telephone(508)398-2231,ext. 1241 T=
Fax(508) 760-3472 = ivicinn
APPLICATION FOR OPERATION-2020 JAN 0 7 2020
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAIL
NAME CJI -P R.L,t 5 1-„ 44 HOME TEL.NO.
STABLE ADDRESS
MAILING ADDRESS(IF DIFFERENT)
EMERGENCY CONTACT(NAME/PHONE#)
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)
BREED
YEAR ACQUIRED
COLOR
SEX
DATE OF RABIES VACCINATION
DATE OF EEE VACCINATION
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
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 taxes and liens must be paid prior to renewal or issuance of your permits.
Please check appropriately if paid: Yes No
SIGNATURE DATE
FEES: STABLE& 1 HORSE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$
12/30/19 ZOR-I- p 4S5