HomeMy WebLinkAbout79 White Rock Poultry Renewal 10.21.26TOWN OF YARMOUTH
HEALTH DEPARTMENT
POULTRY LICENSE APPLICATION
RECElvED
1cT 2120?6
HE{LTH DEPI
FEE: l-9 CHICKENS $30.00
>IO CHICKENS $.IO.OO
ROOS'I'ER (SPECI.{L.\PPRO! L REQ[ IRED B\ BOARD OF TIEALTH)O
NO ROOSTER tr
RENEWALx
NEW APPLICATIONtr
If this is a new application, please attach a copy of your properties plot plan showing lot lines and location of
stable, pen, and all enclosures. Also, a written letter or statement signed by all abutters to the property must be
included with this application.
PLEASE DO NOT INCREASE THE NUMBER OF FOWL WITHOUT PRIOR PER]VilSSION OF THE
IIEALTH DEPARTMBNT
# OF FOWL 14
# OF PENS/COOPS 1
# OF ROOSTERS 0
FOR INSPECTOR: ACCESS COOP FROM CAMP ENTRANCE AT 20 LINNELL LANE
NAME SANDY RUBENSTEIN cAMP WINGATE*KIRKLAND
ADDRESS 79 WHITE ROCK ROAD YARMOUTH PORT, MA 02675
MAILTNG ADDRESS (IF DIFFERENT)
EMAIL ADDRESS HEYSANDY@SAMPryK.g6M ""ffib lva vtqo
TYPE OF SHELTER (WOOD, CONCRETE, ETC.)
WOOD SHED
SIZE OF YARD/PEN AREA
20' x 20'
# OF WATER OUTLETS
0
#OtrWATERTROUGHS
1
TYPE OF STORAGE FACILITY USED FOR FEED/GRAIN
METAL AND PLASTIC CONTAINER IN GARAGE
TYPE OF STORAGE FACILITY USED FOR MANURE
RUBBER COMPOSTER
METHOD OF DISPOSAL OF MANURE
COMPOST OR RUBBISH
HOW OFTEN?WEEKLY
PEN AREA ENCLOSED BY WHAT TYPE OF FENCING?112 X 48 INCH HARDWARE CLOTH
The Town of Yarmouth taxes and liens must be paid prior to renewal or the issuance of your licenses.
Please check if appropriately paid: YESE NO tr
All licenses shall expire on December 3l't. This license must be renewed ANNUALLY.
SIGNATURE OF APPLICANT
LICENSE
DArE 1012012026