HomeMy WebLinkAboutApplication 1
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TOWN OFARMOUTH Board of
�t� Health
%;:,71146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451
Telephone(508)398-2231, ext. 1241 Health
Fax(508)760-3472
APPLICATION FOR OPERATION-2020 JAN 0 g 202
POULTRY
HEALTH D PTS
PLEASE COMPLETE ALL QUESTIONS
E-MAILAgr
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NAME0---1 -4)16-7 4%71 5'aui HOME TEL.NO. ,5---eier 2 2 fi —6577
LOCATION ADDRESS / y���ri 5 ( i C,G1i14 — d.2 6
y o� 73
iP
MAILING ADDRESS DIFFERENT)
NUMBER OF FOWL 013" NUMBER OF PENS/COOPS 2 NUMBER OF ROOSTERS
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER SIZE OF YARD/PEN AREA
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS WATER TROUGHS
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN
TYPE OF FACILITY USED FOR MANURE STORAGE
METHOD OF DISPOSAL OF MANURE HOW OFTEN
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING?
Y 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 hens must be paid prior to reneal or issuance of your permits.
Please check appropriately if paid: Yes ✓ No
SIGNATURE N'/ ... — .., DATE / — — Zo
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: ✓ POULTRY:_is/chick= i346000
or more Chickens
/ ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE:$ O.O C)
12/30/19