APPLICATION FORM FOR HORSE STABLING PERMIT

NAME:___________________________________

ADDRESS:________________________________

TELEPHONE:______________________________

I HEREBY REQUEST A PERMIT FROM THE BOARD OF HEALTH TO STABLE ______ HORSE (S) AT THE ABOVE ADDRESS.

PROPERTY LAND AREA (ACRES OR FEET):_______________________

SIZE OF STABLE:________________________

NUMBER OF STALLS:______________________

SIZE OF CORRAL:________________________

SIZE OF GRAZING AREA:__________________

DISTANCE OF STABLE TO ABUTTERS:___________________________

DISTANCE OF CORRAL AND GRAZING AREA TO ABUTTERS:______________

DRAINAGE:______________________________

VENTILATION:___________________________

UPKEEP:________________________________

BEDDING:_______________________________

WATER SUPPLY: PUBLIC______  WELL ______

STORAGE AND DISPOSAL

OF MANURE:_____________________________

CONVENIENT TIME FOR INSPECTION: AM _____  PM _____

SIGNATURE:_____________________________