HomeMy WebLinkAboutApp-License The Commonwealth of Massachusetts Fee
/.11' Town of Yarmouth $30.00
Stables License
Number: BOHS-15-1252-06 Issue Date: 1/1/2021
Mailing Address: Location Address:
ROBIN JOLY, DVM 154 SUMMER ST
P.O. BOX 219 YARMOUTH PORT. MA 02675
YARMOUTHPORT, MA 02675
IS HEREBY GRANTED A 2021 LICENSE
This license is granted in conformity with the statutes and ordinances relating thereto,
and expires December 31, 2021 unless sooner suspended or revoked and is not
transferable.
Conditions
Allowed to have up to a total of 2 horses 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
Bruce G. Murphy, H, R.S.,CHO
Health Director
TOWN OF YARMOUTH Board of
:Ol • Health
1 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451 Health
Telephone(508)398-2231,ext. 1241
Division
Fax(508)760-3472
II
ARPLICATION FOR OPERATION -2021
STABLE PLEASE COMPLETE ALL OUES'tIONS E-MAIL t�!�SJ LV � cj 1�_/L-'9c4 net.
NAME obi n 0 t V (Yl HOME TEL.NO 36Z (. 34 8
STABLE ADDRESS S en in er 5+ l�C, r f 1 o%A4%\ ' 'or+L
MAILING ADDRESS(IF DIFFERENT( j)( Q C' l��rn0lk411 Oc T Oo�(0
J 7S
EMERGENCY CONTACT(NAME/PHONE#1 O 6 — a c,l 7 7 to
VETERINARIAN(NAME/PHONE#) A )a - LI
TOTAL NUMBER OF HORSES/PONIES I TOTAL NUMBER OF STALLS \.
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) T'1 -r.p q
BREED f r o\b'1 U n
YEAR ACQUIRED at r
COLOR q Cc
SEX I'1(1 O\C'Q
DATE OF RABIES VACCINATION 7 at 9_
DATE OF EEE VACCINATION -7 a o?_ 2
DATE OF OTHER VACCINATIONS
TYPE OF STABLE/SHELTER Li) 0 O 9 SIZE OF CORRAL AREA a C) ,c 9 b
(WOOD,CONCRETE,ETC.)
NUMBER OF HOSE BIB WATER OUTLETS DRAINS WATER TROUGHS
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN (� 0,941
S-1GI i 1 c b c\r n
TYPE OF FACILITY USED FOR MANURE STORAGE S C3 CI (C G e C
METHOD OF MANURE DISPOSAL v\S Q. t Cl txt c E n S FREQUENCY C CAal 0 Ordh
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? 'PC)S-t Q« `( CX
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.
Town of Yarmouth taxes and liens must be paid Vior to renewal or issuance of your permits.
Please check appropriately if paid: Yes V No
SIGNATURE �\3\C1 S `.30\i6 v c ' 1 DATE S "_3 a
FEES: STABLE& 1 HORSE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ ?�
12/30/19
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