HomeMy WebLinkAbout2022 The Commonwealth of Massachusetts Fee
Town of Yarmouth $35.00
Stables License
Number: BOHS-15-1245-07 Issue Date: 1/1/2022
Mailing Address: Location Address:
CHARLES CLARK JR. 160 WINSLOW GRAY RD
435 LONG POND RD WEST YARMOUTH. MA 02673
HARWICH, MA 02645 •
IS HEREBY GRANTED A 2022 LICENSE
This license is granted in conformity with the statutes and ordinances relating thereto,
and expires December 31, 2022 unless sooner suspended or revoked and is not
transferable.
Conditions
Allowed to have up to a total of 3 horses at above address.
PLEASE POST LICENSE ON PREMISES.
Board Hillard Boskey,M.D.,Chairman
Mary Craig,Vice Chairman
of Charles T.Holway,Clerk
Debra Bruinooge
Health Eric Weston r`1
, 3
Bruce G.Murphy,, PH,R. ., C afnes G. Gardiner
Health Director/A ist nt Health Director
y�rt
TOWN OF YARMOUTH
r
Board of
„ Health
---a ; 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSE 02664-24451
_ MTIICHEE8E M ° Telephone(508)398-2231, ext. 1241 = Health
Fax(508)760-3472 "�"'o"
APR 6 2022
APPLICATION FOR OPERATION- 20 2 HEALTH DEPT.
STABLE
PLEASE COMPLETE ALL QUESTIONS E-MAILban i cjq. Y.Q .(m
NAME 406 e.A -sc. HOME_T. L.NO. 50i-71s_ -s(:?
�nJ tl v+A 45°?" �47t. -87g1
STABLE ADDRESS 160 `Jl1 11 vreJ t-.1
MAILING ADDRESS(IF DIFFERENT) 4� .cishj W rI 4 I 04-0-6
EMERGENCY CONTACT(NAME/PHONE#) 04\As 1•. ((AAA() w,fbaVl a - 7�b`$ 3a1
VETERINARIAN(NAME/PHONE#) Dtt. till if r;nA Ce4 y.e
TOTAL NUMBER OF HORSES/PONIES TOTAL NUMBER OF STALLS
PLEASE NOTE:PLEASE DO NOT INCREASE THE NUMBER OF ANIMALS
WITHOUT PRIOR PERMISSION OF THE HEALTH DEPARTMENT.
PLEASE LIST EACH HORSE/PONY/DONKEY/CD SEPARATELY:
DI e-es
ANIMAL NAME(IF APPLICABLE) IV,a e, (3a 6190
BREED A it I ' ' 9 • Du.it4 Mast -
YEAR ACQUIRED aZ ('t►'S I6 e&
COLOR Q i vit, tacit A$IZ,x"„
SEX . Cp 1&t
DATE OF RABIES VACCINATION 5 11 a'a city �'D
DATE OF EEE VACCINATION ' l'j l P' S i tl .
DATE OF OTHER VACCINATIONS
4014* A1°3c
TYPE OF STABLE/SHELTER W 4.- SIZE Or CORRAL AREA t-tov30 2°P30
CONCRETE,ETC.)
NUMBER OF HOSE BIB WATER OUTLETS 3 DRAINS WATER TROUGHS 6
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN V+n (7ja1'V,ZIS
TYPE OF FACILITY USED FOR MANURE STORAGE Y2s C,j5
METHOD OF MANURE DISPOSAL T o ) FREQUENCY Gt('u` t v- _ Qicky�r�e
CORRAL/PEN AREA ENCLOSED BY WHAT TYPE OF FENCING? Woo C�E,u,i� 1 r'Vy� `J
OTHER FARM ANIMALS MAINTAINED AT PREMISES? YES NO
(PLEASE 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 paid prior to renewal or issuance of your permits.
Please check appropriately if paid: Yes V No
SIGNATURE f\;`4 ' ' E ( \ROO DATE Xi?)) .,0 X>
FEES: STABLE& 1 .`HORSE $30.00(+$5.00 each additional horse/animal) �TOTAL DUE:$ 3��'
12/30/19