HomeMy WebLinkAboutApp-License The Commonwealth of Massachusetts Fee
Town of Yarmouth $30.00
Stables License
Number: BOHS-15-1252-07 Issue Date: 1/1/2022
Mailing Address: Location Address:
ROBIN JOLY, DVM 1 ,4 SUMMER ST
P.O. BOX 219 YARMOUTH PORT. 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 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 C�
Bruce G. Murphy, MPH, S., /James G. Gardiner
Health Director/Assistant Health Director
TOWN OF YARMOUTH
Board of
Health
=�►_ 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451 Health
MATTACHEESE
Telephone(508)398-2231,ext. 1241
Fax(508)760-3472 Division
APPLICATION FOR OPERATION - 2022
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAIL Y S
NAME G J n U L HOME TEL.NO.508-3&D, - (03 )
STABLE ADDRESS 1 1�) S l.h 1611\ e r �`� J CiW (h c a-}h PQ r t' m Q 3 I'
MAILING ADDRESS(IF DIFFERENT).1?)p)( al 9 LIo\r rn C (A YYl Ck
EMERGENCY CONTACT(NAME/PHONE#1 5CA 3 - ( 3 I FS
VETERINARIAN(NAME/PHONE#j Rob 1 I\ J C)f`) m
TOTAL NUMBER OF HORSES/PONIES 1 TOTAL NUMBER OF STALLS
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF ANIMALS REC 'VED
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT. APR 2 Q Z Z
PLEASE LIST EACH HORSE/PONY/DONKEY/COW SEPARATELY:
HFAtTH Ll="PT'.
ANIMAL NAME(IF APPLICABLE) - j#-#-,-pr-
BREED Arc k-itr i\
YEAR ACQUIRED Imp
COLOR (s,
SEX n r
DATE OF RABIES VACCINATION a-Jo-aa
DATE OF EEE VACCINATION a-1O -
DATE OF OTHER VACCINATIONS
TYPE OF STABLE/SHELTER (A)Q O]> SIZE OF CORRAL AREA I X��
(WOOD,CONCRETE,ETC.)
NUMBER OF HOSE BIB WATER OUTLETS — DRAINS — WATER TROUGHS
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN qra to Ar\ h eU V �d-
TYPE OF FACILITY USED FOR MANURE STORAGE man lit
r
METHOD OF MANURE DISPOSAL `,(S- 1 N (p\c' e h FREQUENCY Ck tvi1 to p�I.W.(Sr;.n G
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING?''pc c_,-}- an A r-ox; ` a
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 or to renewal or issuance of your permits.
Please check appropriately if paid: Yes No
SIGNATURE /-K)t)`ir\-• 5 � m DATE LI `�-�-
FEES: STABLE& 1 HORSE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ 6��
12/30/19