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_.r _ TOWN OF YARMOUTI — Boaro
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Health-
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%kii 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-.445UAN 1
Telephone(508)398-2231,ext. 1241
Fax(508)760-3472 .;. , _ • • inn
APPLICATION - ei ) :
FOR OPERATION2020 _,i_ - 4:: - I'a
SHEEP/GOATS FE;: 1-8 animals $30.0 I
9 or more animals $35.00
Renewal
PLEASE COMPLETE ALL QUESTIONS New Application
E-MAIL 461160 i N iv 60 M
NAME 1)6Vt5 I aS d Lek.4 Ca.. S �.f i N�/0 HOME TEL.NO. C fl IM n. • C o t
ADDRESS l 8 i;'J N M ac(t 1.-�-�— 'F' Poe 36 i"y//7
MAILING ADDRESS(IF DIFFERENT)
EMERGENCY CONTACT(NAME/PHONE#)
VETERINARIAN(NAME/PHONE#) M At I)PA- Ce S`p fL..� S O 3 6 0_36,y1,(. O Tsp1100 .., 9/i
TOTAL NUMBER OF ANIMALS
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIMALS
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
PLEASE LIST EACH SWINE/SHEEP/GOAT SEPARATELY:
ANIMAL NAME(IF APPLICABLE) 6./i 113 V r 1-At r9
BREED 'Nt^ ot, 6 V- l F ty-oc, 5 '
{ #YEARS OWNED
el-
COLOR
OSEOR �ae.IC�w Wh' 4/ Ifu
DATE OF RABIES VACCINATION 10/ / S JO/i g_
DATE OF EEE VACCINATION
DATE OF OTHER VACCINATIONS v` l
TYPE OF STABLE/SHELTER Vaud SIZE OF CORRAL AREA
a 3 O U .
a,
(WOOD,CONCRETE,ETC.)
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN
--ri N cco S (A.,voo(
TYPE OF FACILITY USED FOR MANURE STORAGE C.o- V a S
METHOD OF DISPOSAL OF MANURE C. 0 fr y°S`} -7 U(/frt P HOW OFTEN t ```-0'"-k
IS CORRAL/PEN AREA ENCLOSED BY FENCING? YEtNO TYPE OF FENCING ad /u/
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO Oc
(PLEASE NOTE: POULTRY, HORSES, PONIES, DONKIES REQUIRE SEPARATE LICENSURE.)
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 pad: prior to renewal or issuance of your permits.
Please check appropriately if paid: Yes No
SI
12/30/19ATURE ��� 0 — DATE I —PO