HomeMy WebLinkAbout2021 The Commonwealth of Massachusetts Fee
Town of Yarmouth $35.00
Stables License
Number: BOHS-15-1245-06 Issue Date: 1/1/2021
Mailing Address: Location Address:
CHARLES CLARK, JR. 160 WINSLOW GRAY RD
C/O JULIE CLARK CAMPBELL WEST YARMOUTH. MA 02673
160 WINSLOW GRAY ROAD
WEST YARMOUTH, MA 02673
IS HEREBY GRANTED A 2021 LICENSE
This license is granted in conformity with the statutes and ordinances relating thereto,
and expires December 31, 2021 unless sooner suspended or revoked and is not
transferable.
Conditions
Allowed to have up to a total of 3 horses at above address.
PLEASE POST LICENSE ON PREMISES.
Board Hillard Boskey, M.D.,Chairman
Mary Craig, Vice Chairman
of Charles T. Holway,Clerk
Debra Bruinooge
Health Eric Weston
Bruce G.Murph , MPH,R.S.,CHO
Health Director
CA. r TOWN OF YARMOUTH
Board of
Health
1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-24451 Health
Telephone(508)398-2231, ext. 1241
Division
Fax(508)760-3472 '
APPLICATION FOR OPERATION -2021 Hr;^! T-
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAIL bub an►9a•j(...0 5'" (, COW)
NAME CL-Ifl CI a/ 31<, HOME TEL.NO. 5 jJ g-77 c 5�Q 2
STABLE ADDRESS I60 k)i VI AN Col
, PA �J(JQS 9 P.svvl ,�U, ii� 1 a jja(G-)3 "71
MAILING ADDRESS(IF DIFFERENT) 1$ Li 35 Vt.'n '" Di-- Ve CidrWi& r Oct(DJ:m5 0 K 1 0 S w S muoil
EMERGENCY CONTACT(NAME/PHONE# lail Svc-776'-2 7 ai0ahl)
VETERINARIAN(NAivE%/P11ONE i/)ONO;`wi V, ( c ' Nm ?o V400-f / 1 D
TOTAL NUMBER OF HORSES/PONIES a TOTAL NUMBER OF STALLS 3
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) Vac.`G G(,, u
BREED P,rka1hblevY, 0,A4-..e40r54
YEAR ACQUIRED CI ytacA 15 year's
SEXOOR �' ts1A�fPir4A"�t �`'�-C74Y{'�DATE OF RABIES VACCINATION 5/1 Z!a,1 5"i it j. 1
DATE OF EEE VACCINATION 5-1/Z ?I S l i7 pi
I
DATE OF OTHER VACCINATIONS JP g.1 1.44 Jl`)17/2 1
TYPE OF STABLE/SHELTER 'W.)OaSIZE OF CORRAL AREA 030 3V��
(WOOD,CONCRETE,ETC.) / y� �
NUMBER OF HOSE BIB WATER OUTLETS 0\ DRAINS WATER TROUGHS b Ill(,
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN To (. tt LC
TYPE OF FACILITY USED FOR MANURE STORAGE 1rc"0s
METHOD OF MANURE DISPOSAL PIQY w€ teft ti � "D u FREQUENCY
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? MA Qi,Q,vvN
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO
(PLE E NOTE: POULTRY, SWINE, SHEEP, CATTLE, GOATS REQUIRE SEPARATE LICENSURE.)
V 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 rior to renewal or issuance of your permits.
Please check appropriately if paid: Yes V No
SIGNAT L• (04A1A IX Le ) DATE pt ID.a17�(
FEES: STABLE& 1 HORSE $30.00(+$5.00 each additional horse/animal) TOTAL DUE:$ ,
1250,19 5-41'11 C .