HomeMy WebLinkAboutApplication and WC The Commonwealth of Massachusetts Fee
Town of Yarmouth $35.00
Stables License
Number: BOHS-15-1252-05 Issue Date: 01/01/2020
Mailing Address: Location Address:
154 SUMMER ST
ROBIN JOLY YARMOUTH PORT,MA 02675
P.O. BOX 219
YARMOUTHPORT,MA 02675
IS HEREBY GRANTED A 2020 LICENSE
This license is granted in conformity with the statutes and ordinances relating thereto,
and expires December 31, 2020 unless sooner suspended or revoked and is not
transferable.
Conditions
Allowed to have up to a total of 2 horses at above address.
PLEASE POST LICENSE ON PREMISES.
Board Hillard Boskey,M.D.,Chairman
Mary Craig,Vice Chairman
of Charles T.Holway,Clerk
Debra Bruinooge
Health Eric Weston t /
Bruce a Murphy,MPH,R.S.,C O/my L.von Hone,R.S.,CHO
Health Director/Assistant Health Director
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ife°r .r TOWN OF YARMOUT
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1146 ROUTE 28, SOUTH YARMOUTH,
MASSACHUSETTS 02664-24. 51 -
Telephone(508)398-2231, JAN I el
p ext. 1241 9
Fax(508)760-3472
Division
max' WEALTH �P
APPLICATION FOR OPERATION-2020
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAIL rs
NAME MG‘:. �Gt,.y 3 0 U"� �Cr1Cq n e+ .01 P-}-
HOME TEL.NO.
STABLE ADDRESS 1 5'-'1 S m mer- 5-- a
MAILING ADDRESS(IF DIFFERENT) 9 (7 • Bo( a L\Q c ;r ovA Oct 1i1 pr ca.615--
EMERGENCY CONTACT(NAME/PHONE#) a GR' — H t D'"t (I) `
VETERINARIAN(NAME/PHONE#) S Eos '1- 7 ( 11
TOTAL NUMBER OF HORSES/PONIES I TOTAL NUMBER OF STALLS a
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) T t I
BREED P r n h n
YEAR ACQUIRED ao O c1
COLOR
SEX m t
DATE OF RABIES VACCINATION I g-/q
DATE OF EEE VACCINATION 6_#g-/9
DATE OF OTHER VACCINATIONS c - /6— 19
TYPE OF STABLE/SHELTER �nU
W oa d SIZE OF CORRAL AREA a 5 X 3 0
(WOOD,
NUMBER OF HOSE BIB WATER OUTLETS CONCRETE,ETC.)
INS ROUGHS
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN s r act b;ns p likS tr bar I
TYPE OF FACILITY USED FOR MANURE STORAGE (..A5-e_ '01/4.1‘u -c - n oa Oki--d-e%s
METIIOD OF MANURE DISPOSAL FREQUENCY
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? '{70 si- pt.n r Q 1
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 cJL S �y l� V M DATE H g'—a6
FEES: STABLE& 1 HORSE $30.00(+$5.00 each additional horse/animal)
TOTAL DUE:$ v Sa
12/30/19
2.019 - U P a 2 t+nesE5