HomeMy WebLinkAbout2022-App-Licensing The Commonwealth of Massachusetts Fee
Town of Yarmouth $40.00
Poultry License
Number: BOHP-15-1203-07 Issue Date: 1/1/2022
Mailing Address: Location Address:
SANDY RUBENSTEIN 79 WHITE ROCK RD
CAMP WINGATE*KIRKLAND Yarmouth Port. MA 02675
79 WHITE ROCK ROAD
YARMOUTHPORT, MA 02675
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.
Conditions
Allowed to have up to a total of 17 chickens 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 I
Bruce G. Murphy. MP R.S., -O/James G. Gardiner
Health Director/Assistant Health Director
(6f ''AVi
TOWN OF YARMOUTH Board of
a Health
1 146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451
MATTACHEE E Health
`'►*•n Telephone(508)398-2231, ext. 1241
F (508)760-3472
11kv% axn
APPLICATION FOR OPERATION - 2022/2021
POULTRY
PLEASE COMPLETE ALL QUESTIONS
E-MAIL HEYSANDY@CAMPWK.COM
NAME CAMP WINGATE KIRKLAND-SANDY RUBENSTEIN HOME TEL.NO. 508-362-3798
LOCATION ADDRESS 20 LINNELL LANE YARMOUTH PORT, MA 02675
MAILING ADDRESS (IF DIFFERED I ) 79 WHITE ROCK ROAD YARMOUTH PORT, MA 02675
NUMBER OF FOWL 16 NUMREROFPENS/COOPS 1 NUMBER OF ROOSTERS 0
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER WOOD SHED SI,ZF OF YARD/PEN AREA 20 X 20
(WOOD,CONCRE1'E,I)
NUMBER OF WATER OUTLETS 0 WATER TROUGHS 1
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN ALUMINUM CAN WITH LID STORED INSIDE GARAGE
TYPE OF FACILITY USED FOR MANURE STORAGE RUBBER COMPOSTER
METHOD OF DISPOSAL OF MANURE COMPOST OR RUBBISH HOW OFTEN BI-WEEKLY
MI AREA ENCLOSED BY WHAT TYPE OF FENCING? 1/2 X 48 INCH HARDWARE CLOTH
_ 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 LE1-('ItR 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 DATE
'IIE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIORYI AR'S TOTAL.
FEES: 2- POULTRY: 1-9 chickens $30.00
10 or more Chickens $40.00
ROOSTER (NOTE SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DI rS4i53 APR `402?
HEALTH DEPT.
I 'I