HomeMy WebLinkAboutApplication 4-24--Z16/0 6.4 3—(S-- /a-crs-_06"
TOWN OF YARMOUTH Board of
it*
1146 ROUTE 28, SOUTH YARMOUTH, 02664-24451
� �����"'' � MASSACHUSETTS 508 Telephone
( )39 -
8 2231,ext. 1241 JAN 2 7
Fax(508)760-3472 "n
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APPLICATION FOR OPERATION-2020 &7314gigtite°
STABLE • r£, U
PLEASE COMPLETE ALL QUESTIONS E-MAIL
NAME CJ' vatic (` Gt�r/� R. HOME TEL. - —
NO. �p� "7� � (ZS
STABLE ADDRESS U b 0 Wi r)51a r- �� v 'vYk `�� S��'1�5' 5b
MAILING ADDRESS(IF DIFFERENT) 4 L oYN , 01 mitt
EMERGENCY CONTACT(NAME/PHONE#) Jv,`K 64014- C 04/11
VETERINARIAN IAN(NANE/PHONE--#)--ber-Thyly
TOTAL NUMBER OF HORSES/PONIES d TOTAL NUMBER OF STALLS 1
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) N jµ
BREED ?A IficW tvt.
YEAR ACQUIRED rS 16 -ears
COLOR CARL,+(,►�,1t t.g�ww -��h r`8l lxlt Wwin p L}ua1
SEX v�nlY�-e llAcki�
DATE OF RABIES VACCINATION $id;,,q - 1,„14 jq
DATE OF EEE VACCINATION (ao q '1I '(a-o1 cI
DATE OF OTHER VACCINATIONS i I S t ao jq -)t S(at '
TYPE OF STABLE/SHELTER \IJ QDd- PGI;1!'f'1 SIZE OF CORRAL AREA uD v 3 O ���`3 v
(WOOD,CONCRETE,ETC.) 3 30
NUMBER OF HOSE BIB WATER OUTLETS DRAINS WATER TROUGHS 6 a}„L pW PW--TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN 1-TNA,�y ,e,�
TYPE OF FACILITY USED FOR MANURE STORAGE 'v' ,
METHOD OF-iLTAivu'Ri~,DISPOSAL atm-by -- - �� _
FREQUENCY Coup\ kV V S �AtV�v',.jY
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? C)(14,tV\ L -(-
OTHER
—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.
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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 �, I, C Q �•�)�� DATE . aa. , aO W
FEES: STABLE& 1 HORSE $30.00(+$5.00 each additional horse/animal)
TOTAL DUE:$ ® ,Q�
12/30/19 Peg_.20%1 ; uQ '('p 3 HtRgBS
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