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2. Borough of Hawthorne

   Health Department 

   445 Lafayette Avenue, 2nd Floor
   Hawthorne, NJ 07506
   Phyllis Wooldridge

   Phone: 973-427-4012  ~  Fax: 973-427-1882

   https://hawthornenj.org/269/Health

4. Permission is granted unto:*
6. Address*

8. To keep and maintain live poultry or live animals under resolution of the Board of Health of the Borough of Hawthorne dated ________ under the following specifications:

10. Type of Animal
12. Type of Poultry
14. Location of animal or poultry*
16. Type of enclosure
18. Maximum number of same

20. Applicant agrees not to keep a greater number of above than the amount specified and to abide in all detail with Ordinance No. 917 under which this Permit is issued and with all other Ordinances or rules governing the keeping of live animals or poultry. 

22. Annual Fee: $20 per species - January 1 to December 31 

    Cash or Check only - Checks made payable to: The Borough of Hawthorne

    Please mail or deliver application and fees to the Health Department NO LATER THAN January 31st.  Your license will be mailed to you, Please post in public view. 

    Any questions may be directed to the Registrar at: pwooldridge@hawthornenj.org

    
    

24. Secretary Board of Health*
25. Date*
Leave This Blank:


26. Print Only

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