HomeMy WebLinkAbout2022 App-License-Certifications The Commonwealth of Massachusetts Fee
Town of Yarmouth $40.00
Poultry License
Number: BOHP-15-1220-07 Issue Date: 1/1/2022
Mailing Address: Location Address:
THOMAS ORTON 26 KENCOMSETT CIR
26 KENCOMSETT CIRCLE YARMOUTH. MA 02675
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 25 chickens, 1 rooster 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 2
Bruce G. Murphy. MPH. R4., HO/James G. Gardiner
Health Director/Assistant Health Director
TOWN OF YARMOUTH Board of
,syn, Health
�► 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451
MATTACHEESE
''��" Telephone(508)398-2231, ext. 1241 Health
Division
Fax(508)760-3472
APPLICATION FOR OPERATION-2022
POULTRY
PLEASE COMPLETE ALL QUESTIONS
E-MAIL hAvo b 1►.2�•I`�i�-� a -& M4-
NAME IT, it.)4Yel.S HOME TEL.NO. $"c $ 3(L -7'7 g
LOCATION ADDRESS d_.L \I,-e Ap.tx. 6 C. ctdra
MAILING ADDRESS(IF DIFFERENT) l
NUMBER OF FOWL- ZJ NUMBER OF PENS/COOPS NUiMHLR OF ROOSIERS `,-
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER v..)0031/4 SIZE OF YARD/PEN AREA\to"")--
(WOOD,
o&(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS l WATER TROUGH?
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN l C/VC RECEIVED
TYPE OF FACILITY USED FOR MANURE STORAGE MAY 0 4 2022
METHOD OF DISPOSAL OF MANURE Ga ,c o HOW OFTEN HEALTH DEPT.
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? LaS b
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 Za DATE II f 2 ('J
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: I POULTRY: 1-9 chickens $30.00
10 or more Chickens $40.00
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
od
TOTAL DUE: $ tf1
12/30/19
The Commonwealth of Massachusetts
DEPARTMENT OF AGRICULTURAL RESOURCES
DIVISION OF ANIMAL HEALTH
T� INSPECTOR'S COPY
(Owner's Name) (Farm Name)
(Address where animals are kept - street number and name)
(Town) (Zip code) (Phone number)
Dealer: YesF–]
1. Cattle (Adult = 2 years & over) Adult Young
Dairy —
Beef
Steers / Oxen
2. Goats (Adult =1 year & over) _
3. Sheep (Adult =1 year & over)
4. Swine: Breeders —
Feeders _
S. Llamas / Alpacas —
6. Equines: Horses/ Ponies _
Donkeys / Mules
Stable use: Private _Boarding Training _Rental— Lessons_
7. Poultryr Chic)<eras 7t�Turkeys
Ratites (Ostrich, Emu) Waterfowl Gamebirds
8. Rabbits
9. Other
10. Do animals listed appearto be free from contagious disease?=�
11. Are accommodations adequate with reference to situation, cleanliness,
light, ventilation and water supply? (explain briefly)
I hereby certify that I have this day inspected these animals and the
conditions under which they are kept.
R¢
jd.:i''.i
Date Inspector of Animals (signature)
Form 74
IV