HomeMy WebLinkAbout2021 The Commonwealth of Massachusetts Fee
Town of Yarmouth $40.00
Poultry License
Number: BOHP-17-0431-04 Issue Date: 1/1/2021
Mailing Address: Location Address:
ELENA CENSALE 30 GREYHAMPTON RD
30 GREYHAMPTON ROAD WEST YARMOUTH, MA 02673
WEST YARMOUTH, MA 02673
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 thirty(30)chickens at above address. No roosters allowed.
Board Hillard Boskey, M.D.,Chairman
Mary Craig, Vice Chairman
of Charles T.Holway, Clerk
Debra Bruinooge
Health Eric Weston
MKA
Bruce G. Mu • y, %PH,R.S.,CHO
Health Director
`,.. .•r t
TOWN OF YARMOUTH Board of
Health
Alltii‘
Itflit%7
''11 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-24451 Health
Telephone(508)398-2231, ext. 1241
:;: :'` ''' Fax(508)760-3472 Division
APPLICATION FOR OPERATION -2021 =
POULTRY i 2 LOLj
PLEASE COMPLETE ALL QUESTIONS
E-MAIL /1/ ,- HEALTH DEP
NAME E Lam CEV51La- TO N 6'e//Fj4/ HOME TEL.NO.SOg39'//Z76
LOCATION ADDRESS 30 G2e11/1101C0 TON R 3 W, Y ,/11Q(f-`/ "3
MAILING ADDRESS(IF DIFFERENT) l
NUMBER OF FOWL ..q 0 NUMBER OF PENS/COOPS NUMBER OF ROOSTERS O
PLEASE NOTE: PLEASE DO NOT INCREASE THE NUMBER OF FOWL
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT. / rTYPE OF SHELTER LJ2&Z.) SIZE OF YARD/PEN AREA �
(WOOD,CONCRETE,ETC.)
NUMBER OF WATER OUTLETS WATER TROUGHS (_.
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN 6 (...- cyl-/(f S
TYPE OF FACILITY USED FOR MANURE STORAGE 5/-/f J(/in 6 S /72/X C/,) w 6 f73 /4 f}A/U 2 r"
METHOD OF DISPOSAL OF MANURE I/14 CI LC Ft
O/) p/a h f 5 HOW OFTEN /� s7--�`
�
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? i4 LC fl /f C/IV v w/02 E'
VRENEWAL
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 pri r to renewal or issuance of your permits.
Please check appropriately if paid: Yes i/No
SIGNATURE e�PiytQ- C ?al DATE 7/3/cZ/
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRIOR YEAR'S TOTAL.
,fi oe
FEES: Tu POULTRY: 1-9 chickens 30:0
10 or more Chickens
D ROOSTER (NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
O NO ROOSTER
TOTAL DUE: $
12/30/19
?' IT 04,3l 21 . coC7