724 
Exhibit C. — Selected forms used in the milk inspection service of the District of 
Columbia. 
APPLICATION FOR PERMIT TO SEND OR BRING MILK INTO THE DISTRICT OF 
COLUMBIA. 
To the Health Officer , D. C. 
Sib : In compliance with “An act to regulate tlie sale of milk in the District of 
Columbia, and for other purposes.” I hereby make application for a permit to 
send or bring milk into said District from the premises described below, located 
r Whole milk. 
Number of shipments per day Total number of gallons j Skim milk. 
I Cream. 
Shipped in — Wagon Boat B. and O. R. R B. and P. 
R. R 
Time of delivery Place of delivery 
Consigned to 
Description of Premises, 
building. 
Brick Frame Stories high 
Condition 
Is any part of it used for any other than dairy purposes? 
If so, specify, in the space for remarks, what parts of it are so used, and the 
purposes for which used. 
Room for Cattle. 
Size Long Wide High 
Floor, kind 
Condition 
Is it properly sloped and guttered? 
What disposition is made of the drainage? 
Ventilation and lighting. How accomplished? 
Windows. How many? 
Location 
Size 
Are windows glazed? 
V entilators. How many ? 
Kind 
Location 
Size 
Doors. How many ? 
Location 
Stalls. Where located ? 
How many? 
Size of each? wide long- 
wide long 
Are animals of any kind other than cattle kept in this room? 
If so. specify how many, and what kind 
Feeding troughs or bores. How many? 
Kind 
Location 
Condition 
