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TO\TN OF YARMOUTH
1146 ROT]TE 28 SOUTH YARMOUTH
Telephone (5oB) 39a-2231, Ext 241
MASSACHUSE-ITS 0266
Fax (508) 398-2365
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@aA0goBtsBOARD OF HEALTH
APPLICATION FOR OPERATION .2004
POULTRY
Msrqa
\"Ar eS e>l -1At-,HOME TEL. NO 36t"b1?3NAME
4aeADDRESS
NUMBER OF FO 5
TYPE OF SHELTER \Juo
REA ENCLOSED BY WHAT TYPE OF FENCING
OF MOST RECENT INSPECTION OF PREMISES
ER OF PENS/COOPS 3 NUMBER oF RoosrERS ,o
SIZE OF YARD/PEN AREA 3o v3o
(wooD,CoNCRETE. ETC,)
WATER TROUGHS U
1
MAILING ADDRESS (TF DIFFERENT
NUMBER OF WATER OUTLETS .1
TYPE OF STORAGE FACIUTY USED FOR FEED/GRAIN finln t
TYPE OF FACILITY USED FOR MANURE STORAGE rucof
METHOD OF DISPOSAL OF MANURE 0
OTHER FARM ANIMALS MAINTAINED AT PREMISES (please indicate numbers)
I HOW OFTEN
PEN A
,^7 INSPECTED BY
RENEWAL
-
NEW APPLICATION -TFNEwAPPLICATIoN,PLEASEATTACHACoPYoFPLoTPLANSHoWINGLoTLINES
AND LOCATION OF STABLE, PEN, ETC, AND ALL ENCLOSURES. ALSO' A WRITTEN
LETTER OR STATEMENT, SIGNED BY ALL ABUTTERS-TO PROPER'I'Y.
Town ofYarmouth taxes and liens must be pai$ prior to renewal or issuance ofyour permits'
Please check appropriately ifpaid: Yes >i No-
SIGNAT(JRE DATE
THE FULL POULTRY COUNT IS NOT TO EXCEED THE AM OUNT OF PRIOR YEAR'S TOTAL.
FEES: / Pour-rnY $25.00
ROOSTER
TOT
l0/03
'a1 PUp;5 J6,00
(NOTE: SPECIAL APPROVAL REQUIRED FOR ROOSTERS)
LA
PLEASE COMPLETE ALL OUESTIONS
Printed on
Recycled
Paper
TEE COMMO}IWEALTE OT' MASSACHUSETTS
TOWN OFYARMOUTH
BOARD OFHEALTH
PERMITNIIMBER: #04-002
This is to Certi.& that Charles
88 Mill Lane- Yarmouthoort. MA
IS HNREBY GRANTED A LICENSE
For TRY
GRANTED IN ANCE WITH PROVISIONS OF MASSA SETTS GENERAL
l_Aws -APTF,R 1I I - SECTIONS I55 ND 3I
PLEASE POST LICENSE ON PREMISES.
This oermit is crsobd in c{nformitv with futicle M of the Sanitary Code of The Commonwealth of Massachus€tts, andexprles Def€mber 3l - 2004 'uoless sooner susp€nded or revol(ed.
November 19-2003 BOARD OF HEAITH
Bruce GDirector
Mumhv. MPH. R.S.. CHOofHial0i
FEE: $25.00
Rilezikian