HomeMy WebLinkAbout2021 - App-License The Commonwealth of Massachusetts Fee
Town of Yarmouth $30.00
Poultry License
Number: BOHP-17-4130-04 Issue Date: 1/1/2021
Mailing Address: Location Address:
SALLY EVANS 24 WEST GREAT WESTERN RD
P.O. BOX 875 YARMOUTH. MA 02675
HARWICH, MA 02645
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 a total of up to 5 chickens at above address. No roosters.
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 P .S.. CHO
Health irector
TOWN OF YARMOUTH Board of
Health
1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451
YATTA.csusC
'a- 4 Telephone(508)398-2231,ext. 1241 Health
Fax(508)760-3472 Division
APPLICATION FOR OPERATION-2021
POULTRY
PLEASE COMPLETE ALL QUESTIONS •
- �1
E-MAIL LSSr�I e-( e c�J Co M C . r e
NAME (—0 n (1�a /1 HOME TEL.NO. 50 - 3 '? -( of
LOCATION ADDRESS"- a T e&* e . f Q Vac
MAILING ADDRESS(IF DIFFERENT) 0 D 1 5 \o.c&`CJ\ IAA Of—cra btj 5
NUMBER OF FOWL Li NUMBER OF PENS/COOPS NUMBER OF ROOSTERS #
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER Q(woab Coif,ETC.) SIZE OF YARD/PEN AREA
NUMBER OF WATER OUTLETS WATER TROUGHS
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN
TYPE OF FACILITY USED FOR MANURE STORAGE ON
METHOD OF DISPOSAL OF MANURE HOW OFTEN
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING?
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 pai or to renewal or issuance of your permits.
Please check appropriately if paid: Yes I No
SIGNATURE qid /, c Q 11 DATE 9.) a - p� )
THE FULL POULTRY COUNT I OT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: v POULTRY: 1-9 chickens 30.00
10 or more Chickens 40.00
ROOSTER (NOTE:SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER 3 TOTAL DUE:$ O • 0
12/30/19 SEP 0 3 2021
HEALTH DEPT.
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