HomeMy WebLinkAbout2022 App-License The Commonwealth of Massachusetts Fee
Town of Yarmouth $30.00
Poultry License
Number: BOHP-17-4130-05 Issue Date: 1/1/2022
Mailing Address: Location Address:
SALLY HELMAN 24 WEST GREAT WESTERN RD
P.O. BOX 875 YARMOUTH. MA 02675
HARWICH. MA 02645
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 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, MP , R.S., HO/James G. Gardiner
Health Director/Assistant Health Director
---
:' °f r'9 TOWN OF YARMOUTH Board of
g Health
,,i► = 1146 ROLL E 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451
"ATTAcHffsE Health
`'*..o _ Telephone(508)398-2231,ext. 1241
---' U�U�J Fax(508)760-3472 Division
MA`( °9 ZU22
LTN DEPT. A PLICATION FOR OPERATION-2022
HEA POULTRY
PLEASE COMPLETE ALL QUESTIONS /—
E-MAIL 1SS{ 7&f ! Q>
NAME a (' Q -40 / a A6reak
HOME TEL.NO. C C _
LOCATION ADDRESS `�yII 1,QS f- (A)..es 4r4 �l ➢ o Z�
MAILING ADDRESS(IF DIFFERENT)trr f a & � 6�� �h iyve----...,4,—
NUMBER OF FOWL NUMBER OF PENS/COOPS NUMBER OF ROOSTERS
PLEASE NOTE: LEASE DO NOT INCREASE THE NUMBER OF FOWL
7
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
TYPE OF SHELTER SIZE OF YARD/PEN AREA
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS WATER TROUGHS
„n Q
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN c� �/, `�—
Lc
TYPE OF FACILITY USED FOR MANURE STORAGE fi "�. 61
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 paid prior to renewal or issuance of your permits.
Please check appropriately if paid: Yes No
,4) 91A SIGNATURE a, 4 DATE G v- c) .�-
THE FULL POUL'"Y COUN NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
FEES: 9 POULTRY: 1-9 chickens .00
10 or more Chickens Vag
ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
NO ROOSTER
TOTAL DUE: $ <3O a d
12/30/19