HomeMy WebLinkAboutSHEEP,SWINE,GOAT APPLICATION & LICENSE - 2007o
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*oz-oc ITO\TN OF YARMOUT
1146 ROUTE 28 SOUT}I YARMOUTH MASSACHUSETTS 02664'445i
Telephone (508) 39&2231, Exl 241 - Fax (508) 76G3472 '-
BOARD OF HEALTH
APPLICATION FOR OPERATION - 2OO7
SWIIIE/SHEEP/GOATS tr'EE: $25.00
/Renewal
_New Application
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PLEASE COMPLETE ALL OUESTIONS
NAME C-[,4n.; s R;lt-;lr,A I'IOME TEL. NO
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MAILING ADDRESS (IF DtrFERENT)
EMERGENCY CONTACT Q.IA\49IPH6NE 4;
VETERINARIAN (NAME/PHONE #)
TOTALNUMBEROFANIMALS .I_ GCA T I C\\"I
PLEASE LIST EACH SWINE/SIiEEP/GOAT SEPAITATELY
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NO\/ 2 7 2005
EALTH DEPT.
ANiMAL NAME (IF APPLICABLE)
t]REED G-ir r--;r (-qw
# YEARS OWNED 'r\,r \.\^r.
COLOR
DATE OF RABIES VACCINATION
DATE OF EEE VACCINATION
DATE OF OTIIFR VAC C INATIONS
TYPE OF STABLE/SHELTER Woo{
(WOOq CONCRETE, ETC,)
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN \,u
TYPE OF FACILITY TISED FOR MANURE STORAGE
METHOD OF DISPOSAI, OF MANURE
IS CORRAL/PEN AREA ENCLOSED BY FENCING? I'ES
OTI]ER FARM ANIMALS MAINTAINED AT PREMISES?
HOW OFTEN
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(PLEASE NOTE: POULTRY, HORSES, PONIES, N)NKIES RESUIRE SEPARATE IJCENSURE.)
IF NEW APPLICATION, PLEASE ATTACH A COPY OF PTI)T PT.AII SHOWING II)T LIMS A}{D IOCATION OF STABIJ,
PEN, ETC., AI\ID ALL ENCIOSURJS. AISO, A WRITTEN LETTER OR STATEMENT, SIGNED BY ALL ABUT'IERS TO
PROPERTY.
Town of Yarmouth taxes and liens must be paid prior to renewal or issuance ofyour permits.
Please check appropriately ifpaid: Yes rJ No-
,)t DATE ))ESIGNATUREJ RiiHpu'
I
szE oF coRRAL AREA---}-XI-
TEE COMMOhTWEALTH OF MASSACHUSf, TTS
TOWN OF YARMOUTII
BOARD OF HEALTH
FEE: $25.00
This is kr Certify that Charles Bilezikian
88 Mill Lane. Yarmout MA 0267s
IS HEREBY GRANTED A LICENSE
GR ANTED IN ACCORDANCE WITH OVISIONS OF'
MASSACHUSETTS GENERAL LAWS HAPTER II1-SECTIONS 155 AND 3I
PI,F],ASE, POST LICENSE ON PRE
:*dtp""ryt Bsffit9,tf:q8#'v,,ftlt *;t* Y,l"i!"*"f,anita!'of$lc or rhe commonwealth or Massachusetts. and
January 19.2007 tsOARD OF TIEALTI I:Bu,iat* 5, 0oi1a.4 11.5., ebrma,
Jl"L" S/r.1" h.tY., bti.. e/talrao
Robrf 61. Bro.ur, Aa.b
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Ar- qa-J"rr-r, RJV.
Brucs G. Murphy, MPH, R.S., CHO
Director of Health
PERMITNUMBER: #07-001