HomeMy WebLinkAboutApp-License The Commonwealth of Massachusetts Fee
Town of Yarmouth $40.00
Poultry License
Number: BOHP-20-0470-02 Issue Date: 1/1/2022
Mailing Address: Location Address:
GEORGE DERALEAU 345 CAMP ST
345 CAMP ST WEST YARMOUTH, MA 02673
SOUTH YARMOUTH, MA 02664
IS HEREBY GRANTED A 2022 LICENSE
This license is granted in conformity with the statutes and ordinances relating thereto,
and expires December 31, 2022 unless sooner suspended or revoked and is not
transferable.
Board Hillard Boskey,M.D.,Chairman
Mary Craig, Vice Chairman
of Charles T.Holway,Clerk
Debra Bruinooge
Health Eric Weston
Bruce /Murphy, MPH,R.S., CHO
Health Director
°F...-YEA; TOWN OF YARMOUTH
(--
Board of
• -��' Health
-=-gl► i 1 146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451 Health
YATTACHEESE
Telephone(508)398-2231,ext. 1241
Fax(508)760-3472 Division
APPLICATION FOR OPERATION-2022
POULTRY
PLEASE COMPLETE ALL QUESTIONS
/re����® Cor�S'T/�E-MAILNAME _-Bike . J % 53V-' HOME TEL.NO. ice 6 �q//5'n
LOCATION ADDRESS _'3 L/ 5 /k p Sr- /. 2 )/d41 /01 oa6 23
MAILING ADDRESS(IF DIFFERENT) / �/
NUMBER OF FOWL / 1 NUMBER OF PENS/COOPS / NUMBER OF ROOSTERS Of
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT. �I�
TYPE OF SHELTER 4èg Caz?-pC) SIZE OF YARD/PEN AREA (8 8 SJ 74"--
(WOOD,
NUMBER OF WATER OUTLETS C rT WATER TROUGHS /
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN ;/ 19 /
TYPE OF FACILITY USED FOR MANURE STORAGE 'j vmrfG a)41261.577
METHOD OF DISPOSAL OF MANURE �/ N v HOW OFTEN /,-k /7O
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? ao/J3 2/77/e
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 't i'� �J DATE cD/i 7/0 a
THE FULL POULTRY COUNT IS NOT TO EXCEED THE a1IOUNT OF PRIOR YEAR'S TOTAL.
FEES: POULTRY: 1-9 chickens 31 10
10 or more Chickens ; 1 1 1
ROOSTER (NOTE:SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
k<ROOSTER
TOTAL DUE: $
ArZ-Mi o a
12/30/19