HomeMy WebLinkAboutSHEEP,SWINE,GOAT APPLICATION & LICENSE - 2005-J
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TOW'N OF YARMOUf,A-=-.-l
0 7 2005MASSACHLSETTS 0tr64.1 146 ROITTE 28 SOLM{ YARMOLTTH
BOARD OF HEALTH
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\?,APPLICATION FOROPERATION - 2OO5
SWII\E/SHEEP/GOATS Y Renew
_New Application
NAMI]CAonl.s Bilnz,le'",,HOME TEL- NO
ADDRESS fF) r'l I La,n A
MAILING ADDRESS (IF DIFFERENT
: $25.00
VETERINARIAN (NAME/PHONE #)fL
ToTAL NUMBER OF ANIMALS I
C
€,
C.'. )ANIMAL NAME (TF APPLICABLE)
IBREEI)
# YI]ARS OWNED
) fo,tP 3- fr:rrPCOLOR
sEx
ll loq /t folDATE OF RABIES VACCINATION
,rt/ ntt It o-rl ./DATE OF EEE VACCINATION
\' -,,DATE OF OTHER VACCINATIONS
TYPE OF STABLE/S}tr,LTER o
CONCRETE, E1'C.)
d.IYPE OF SI-ORAGE F'ACILITY USED FOR FEED/GRAIN /h "+"1
TYPE OF FACILITY USED FOR MANURE STORAGE
oTruR FAR]vi ANIMATS MAINTAINED AT PREMISES? YES / NO-
(PLEASE NOTE: POULTRY, HORSES, PONIES, DONKIES REQUIRE SEPARATE LICENSURE.)
IF NEW APPLICATION, PLEASE ATIACH A COPY OF PIOT PII\fl SHOWING II)T IINES AIID LOCATION OF STABLE,
PEN, ETC., AND ALL ENCIOSURf,S. AISO, A WRITTf,N LETTER OR STATEMENT, SIGI{ED BY ALL ABUTTERS TO
PROPERTY.
oSIGNA.TTIRI]DATE I L L+l i*l**
PLEASE COMPLETE ALL OI.IESTIONS
(oR-36i.-6,r*?
EMERGENCycoNTACT(NAME/psoue+l f,,r, Df or. 5o8 -36 ry -J.It.J
PLEASE LIST EACH SWINE/SI{EEP/GOAT SEPARATELY:
srTF oF coRRAL AREA___8X8--
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Gnoi
m
METHoD oF Drsposer or r'aar.runr f56.{ - now orrrN-D4Ll}--I-
IS CORRAI-/PEN AREA ENCLOSED BY FENCNCT YCSXNO TYPE OF FENCINC W.O d %* + (E l I
Town of Yarmouth taxes and liens must be paid prior to renewal or issuance ofyour permits
Please check appropriately if paid: Yesi- No-
THE COMMOTTVYEAI,TH OF MASSACEUSETTS
TOWNOT'YARMOUTE
BOARDOFHEALTH
PERMIT N{IMBER:#o5-o02 FEE: Waived
This is to Certily that Charles Bi ezlkian
88 Mill Lane.02675
IS IMRDBY GRANIED A LICENSE
For
ANTF-D TN ACCOR ANCE PROVI IONS OF'
SE TLICE ON PR MISf,S.
&"ws"if#fdtP*q"?s:of rhecommonwealrhof Massachurtrs,and
January i3. 2005 BOARD OF TIEAI'IH:B*la**:1. fudo6, /01,5., ebowa*P"ire m"$";-ob 0tte @otaa-t
Robrl a). Brorrn+ eLrAel*81,.1+ RJY.4r*RJI.
Director of