HomeMy WebLinkAboutSTABLE APPLICATION&LICENSE - 2005o
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TO,$7N OF YARMOUif.JI.
APPLICATION FOR OPERATION - 2OO5
STABLE
F./ho
0 7 2005
II()ME TEL, NO 5oS- gba -t rS3NAMEo
STABLE ADDIiIISS tft;tl Lq,le
vETERTNARTAN(NAME/pHoNE#) fl7t Leer-h
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BOARD OF HEAI,TH
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ANIMAL NAME G APPLICABLE)rrc " ir\t-lrvrrnr,r Slo i ?r.tJv Lr r I ft.,lcv cJ.'e l<r n
BREEI)O) r n'i d7,i,(n ftr n i fl-ltar
# YEARS OWNED IJ lo to 5 r
COLOR 3le tt Bl atZ SlonJ Slae]t flinr lc
SEX F,t'((r
DATE OF RABIES VACCINATION loq lt lolt rt log Ir lo4DATE OF I]EE VACCINATION l tlo4 l )o4 tt lotl tt loV tt 'l oq
DATE O}' o'IIITJR VACCINATIONS
I'OTAL NT]MBER OF I{ORSES/PONIES TOTAL NTIMBER OF STAILS
PLEASE LIST EACH HORSE/PONY/DONKEY/COW SEPARATELY
T\?E OF STABI,E/SI{E],TER Qood. (wooD, CoNCRETE, Erc.)
NUMBER OF HOSE BIB WATER OUTLETS A DRAINS A
TYPE OF S'I'ORAGE I'ACILITY USED FOR FEED/GRAIN aJ-o l<
TYPE OF FACILITY USED FOR MANURE STORAGE
METHOD OF MANURE DISPOSAL B,f X FnTQTTENCY De t/r,
CORRAI/PEN AREA ENCLOSED BY WT IAT TYPE OF I.-ENCING?
OTHER FARM ANIMAI,S MAINTAINED AT PREMISES? YES T/ NO-
(PLEASE NOTE: POULTRY, SWINE, SHEEP, CATTLE, C]OATS REQUIRE SEPARATE LICENSURE)
Y REr.IEwAr
NEW APPLICATION. IF IVEW APPLICATION, PLf,ASE ATTACH A COPY OF PI,OT PLAII SHOWING I,OT
LIhIES A}{D LOCATION OF STABLE, PEN, ETC., AIII} ALL ENCLOSURES. AISO, A
WRIITEN LETTER OR STATEMEM, SIGMD BY ALL ABUTTERS TO PROPERTY.
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Town of Yarmouth tares and liens must be paid pior to renewal or issuance ofyou'permits.
Please cbeck appropriately rfpaid: Yes_-r/ No_
SIGNATURI'DATE I L
FEES: STARLE $25.00 (+ $5.00 tionaI horsc/amimal)
D
LA Pri ted on
Recycled
Paper
1146 ROU]T 28 SOL;TH YARI,IOL:TH ]!{ASSACHUSETTS O,OO,ii']
PLEASE COMPLETE ALL OUESTIONS
MAtr-INC ADDRESS (IF DIFFERENT)
EMERGENCycoNTACT(NArv[e/pHoNEfl -fi; Dcdr'? sot - 36Y -]'83
T ,ro tt
srz.F oF coRIL\L AITEA Px&
WATER 1'IiOUGHS
ToTALDUE:s 55.OO
THE COM]UONWEALTH OF MASSACHUSETTS
TOWN OFYARMOUTH
BOARDOFHEALTH
FEE: $45.00
This is to Certiry that Bilezikian
88 Mill Yarmouthoort- MA
For STABI,ING OF . 5 MINIATI IRE HORSF,S I COW l DONKEY
AT ABOVE ADDRESS. GRANTED IN ACCORDANCE WITH SOF
MASS ACHUSETTS LAWS-CIIAPTER 1 II-SECTIONS I55 AND 3I.
PLEASE POST LICENSE ON PREMISES.
sw H"?LFfSHW.?S" of rhe commonwealth of Massachusetts, and
Januarv 13.2005 BOARD OF TIEALTH:Be*** 5. fu.laq rl.5., &"rh-*
Palti& lWcb.ao , Ut* OLtnaa
Rok t6]. Bro.rrb eLrAeb*Sl,.l+ RJV.Ar-R./v.
Dkector of
PERMIT NUMBER: #05-011
IS HEREBY GRANTED A LICENSE