APPLICATION FOR INDIVIDUAL, NON-COMMERCIAL (PRIVATE) MOORING PERMIT
VALID FOR CURRENT CALENDAR YEAR– NOT TRANSFERABLE
NEW APPLICATION
RENEWAL WITH NO CHANGES FROM LAST
RENEWAL WITH CHANGES
MOORING RELOCATION
PLEASE PRINT AND RETURN WITH A CHECK FOR $25 Payable to: Town Of Guilford
Mail Check and application to: Guilford Harbor Management Commission, Town of Guilford, 31 Park St., Guilford, CT 06437
PERSONAL INFORMATION
MOORING APPLICANT’s NAME : _______________________________________________________________________________________
(LAST)
(FIRST)
MAIL ADDRESS: ______________________________________E-MAIL ADDRESS: _____________________________________________
LOCAL ADDRESS: _____________________________________________
TELEPHONE NO: __________________________
___________________________________
(HOME)
_____________________________
(BUSINESS)
(CELL)
VESSEL OWNER (IF DIFFERENT FROM MOORING APPLICANT)____________________________________________________________
ADDRESS _______________________________________________ E-MAIL ADDRESS: _________________________________________
TELEPHONE NO__________________________
___________________________________
(HOME)
______________________________
(BUSINESS)
(CELL)
VESSEL INFORMATION
VESSEL'S NAME ___________________________________
DOCUMENTATION / CT REG # _________________________________
MAKE OF VESSEL______________________ TYPE ______________________________________________
YEAR _______________
(POWER, SAIL, RUNABOUT, DINGHY ETC.)
LENGTH:_________________ON BOARD HEAD: Yes:
No:
TYPE OF HEAD: Portable:
“Y” VALVE SEALED/LOCKED? Yes:
No:
(Yes is required if overboard discharge capability exists)
Holding tank:
MOORING INFORMATION
REQUEST FOR PERMISSION TO PLACE A MOORING IN: Harrison Cove
Great Harbor/Joshua Cove
Sachem Head
Indian Cove/Tuttles Point
Little Harbor
Shell Beach/Island Bay
Other:____________________________________
ASSOCIATION AFFILIATION/MEMBERSIP: _____________________________________________________________________________
PINPOINT LOCATION: Enter GPS coordinates if available, or attach a copy of a chart or sketch showing ranges and bearings of prominent
landmark and position relative to nearby buoys, channels, fairways and docks:
_____________________________________________________________________________________________________________________
MOORING TYPE: MUSHROOM ANCHOR
(ANCHOR WEIGHT________) POLE PULLEY& LINE
HELIX
OTHER
HEAVY CHAIN: LENGTH __________ DIAMETER __________
LIGHT CHAIN: LENGTH____________DIAMETER__________ PENNANT LENGTH _____________ SIZE _______________________
MONTH/YEAR MOORING TACKLE LAST INSPECTED ____________________ WATER DEPTH (AT LOW TIDE) __________________
ADDRESS / LOCATION USED TO ACCESS MOORING FROM LAND: ________________________________________________________
ADDRESS / LOCATION USED TO EMPTY PORTABLE HEAD (IF INSTALLED)________________________________________________
I AGREE TO THE FOLLOWING: 1.) MY VESSEL MUST BE PROPERLY REGISTERED IN CONNECTICUT.
2.) I AM
RESPONSIBLE FOR REGULAR INSPECTION, AT LEAST ONCE PER YEAR, AND MAINTENANCE OF MY MOORING
TACKLE. 3.) I AM RESPONSIBLE FOR ANY PROPERTY DAMAGE OR INJURY IN THE EVENT THE VESSEL BECOMES
DETACHED FROM ITS MOORING OR THE MOORING LOCATION SHIFTS. 4.) I AM AWARE THAT MY MOORING MUST
HAVE ADEQUATE GROUND TACKLE, PENDANT(S), CHAFING GEAR AND SCOPE FOR THE AREA AND CONDITIONS
EXPECTED. 5.) I HAVE REVIEWED THE “SUGGESTED STANDARDS FOR MOORING TACKLE” PUBLISHED BY THE
HARBOR MANAGEMENT COMMISSION. 6.) A VESSEL RIDING ON ITS MOORING WILL NOT INFRINGE ON OTHER
MOORINGS. 7.) MOORINGS, BY ACTION OF WIND OR CURRENT, SHALL NOT ENCROACH UPON NAVIGATION
CHANNELS MAINTAINED BY THE CORPS OF ENGINEERS, OR INTERFERE WITH ESTABLISHED FAIRWAYS, WHARVES,
DOCKS OR FLOATS. 8.) MOORING BUOYS SHALL BE WHITE WITH A CLEARLY VISIBLE HORIZONTAL BLUE BAND
AROUND THE CIRCUMFERENCE CONSISTENT WITH CONNECTICUT LAW AND SHALL BE LETTERED IN MINIMUM 2”
BLACK LETTERS WITH THE OWNER’S LAST NAME, MOORING REGISTRATION NUMBER AND WEIGHT OF THE
ANCHOR IN POUNDS. 9.) FOR A LINE-AND-POLE ARRANGEMENT, THE MOORING REGISTRATION NUMBER WILL BE
CLEARLY DISPLAYED USING 2” LETTERS 10.) THIS PERMIT IS VALID FOR 2013 AND IS NOT TRANSFERABLE.
SIGNATURE OF MOORING OWNER______________________________________________DATE________________________________
MOORING NUMBER (TO BE ASSIGNED BY HARBOR MASTER):
R4
FOR HARBOR MANAGEMENT COMMISSION (HMC) USE ONLY
HMC TREASURER APPROVAL:_________________ Check Number:_______________
SHELLFISH COMMISSION APPROVAL______________________________________
LOCAL ASSOCIATION APPROVAL (IF APPLICABLE): _________________________
HARBORMASTER APPROVAL:_______________DATE:_______________________ __
MOORING NUMBER: