HomeMy WebLinkAboutApplication a0-00q 6044-s-i542 --QS�
` =_ TOWN OF YARMOUTH Board of
Health
1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24
Telephone(508)398-2231,ext. 1241
Division
Fax(508)760-3472 JAN 0 8 2020
APPLICATION SOLEOPERATION-2020 [ e
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PLEASE COMPLETE ALL QUESTIONS E-MAIL 11%
NAME S'7—Y /3, JeijI„J s U,1 HOME TEL.NO. ?S/7 /�L
STABLE ADDRESS 7 '7 L.57/ jurL,✓'lifterr oz.s7 V/ 6L 4177
MAILING ADDRESS(IF DIFFERENT) ------
EMERGENCY
�EMERGENCY CONTACT(NAME/PHONE#) u a 3? 7$ 5..
VETERINARIAN(NAME/PHONE#) yrrr 7/dL i,v Lt, e „C ( O V .i4
TOTAL NUMBER OF HORSES/PONIES 7 TOTAL NUMBER OF STALLS i/ L/a u?—
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) )7/44.4.041 r
BREED r/-L8
YEAR ACQUIRED a i k
COLOR
SEX ,'`1,444-
DATE OF RABIES VACCINATION 6/ 11.e j 9
DATE OF EEE VACCINATION 1 r
DATE OF OTHER VACCINATIONS if
TYPE OF STABLE/SHELTER 1 rfcr,N - -2n u p S SIZE OF CORRAL AREA S--6,e/7o 6`-o,r/-'”)
(WNUMBER OF HOSE BIB WATER OUTLETSTC.)
CONCRETE,/ DRAINS e.z.74,vim WATER TROUGHS aG/(€7$
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN rit c- Ce2uv, ,
TYPE OF FACILITY USED FOR MANURE STORAGE c3 mow'
METHOD OF MANURE DISPOSAL '/1,Q .zp ' de-2 f-11e,s' FREQUENCY /'4,Z r G,e/ X04 7
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? o-a
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO f
(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 v- ��
DATE / /0,2„ed‘acv
FEES: STABLE& 1 HO` ' $30.00x (+$5.00 each additional horse/animal) TOTAL DUE:$ C30.OO
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12/30/19 tq- opT6sel�(1 1 vi" S.$5