HomeMy WebLinkAboutPOULTRY APPLICATION & LICENSE - 2003# fi'Ao(
TO\7N OF YARMOUTH; i
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{1P1146 ROUTE 28 IiOUTH YARMOLITH
Teleplrone (i08) 398-.1231, Ext. 2,i1
APPLICATION FOR OPERATION - 2OO3
POULTRY
BOARD OF HEALTH
PLEASE COMPLETE ALL OUESTIONS
NAME HoMErEL.No. 34) -L)83tt L n+p.ADDRESS
ryPE oF srrELTEn lr) ooJ (wooD, coNCFsrE, ETc.)
eNUMBER OF WATER OUTLETS WATER TROUGHS O
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN
TYPE OF FACILIry USED FOR MANURE STORACE A)ony
METHOD OF DISPOSAL OF MANURE HowoFTEN Dar/u
OTHER FARM AN]MALS MAINTAINED AT PREMISES (Please indicate numbers)
PEN AREA ENCLOSED BY WI{AT PE OF FENCING?LQ( ?-
F Mosr RECENT rNspEcrroN oF pREMTsES A Na INSPECTED BY 3.4<p lZtnobur'
IF NEW APPLICATION, PLEASE ATTACH A COPY OF PIOT PLAN SHOWING LOT LINES
AND LOCATION OF STABLE, PEN, ETC., AND ALL ENCLOSURES. ALSO, A WRI'I"TEN
LETTER OR STATEME,'iT, SiGI\ED BY ALL ABUTTERS TO PROPERTY.
€
"y
RENEWAL
NEW APPUCATION .
Town ofYarmouth taxes and liens
Please check appropriately ifpaid
must be paidrrior to renewal or issuance of your permis.
Yes V No
SIGNATURE
TOTAL DUE: S
t0t02
DATE
ROOSTER
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AMOUNT OF PRTOR YEAR'S
/FEES: '../ POULTRY $25.00
Printed on
Recycled
Paper
J5o c
(NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
TA
Lfl
| 7 ?fifi?
MAILING ADDRESS (IF DTFFERENT)
NUI\BER oF FowL--T.5 NUMBER OF PENS/COOPS 3 NUMBER OF ROOSTERS 13
srTF oF yARD/pEN AwA 10 x 30
PERMITNUMBER: #03-004 FEE: $25.00
This is to Certify ilezikian
88 Mill Lane. Yarmouthoort MA
IS EEREBY GRANTED A LICENSE
For I E
SACHU
LAWS - CHAPTER I,I l-sECTIONS I55 AND 3I.
PLEASE T LICENSE ON
This Dermit is sraded h conbmitv with futicle VI of the $anitarv Code of The Commonwealth of Massachusetts, andexpiles DeEemberll .2001 -unless sooner susPended or revoked.
January 28. 2003 BOARD OF }IEALIII:eh*o?. Kdlrla. lrhta4,.3.r*nt. D. lial*. Vl.D. .'ltauP'lal. A,i*, eut?ad*l?flOonoa
R.7r.
Brrce G
Dire<tor
Mumhv-
of Healtli
S., CHO
TEE COMMOIYWEALTE OF MASSACEUSETTS
TOWNOFYARMOUTH
BOARDOFEEALIE
PRf,:,MISES.