HomeMy Public PortalAboutNew Mooring Permit ApplicationTOWN OF BREWSTER, MASSACHUSETTS
NATURAL RESOURCE / SHELLFISH / HARBORMASTER DEPARTMENT
1657 MAIN STREET BREWSTER, MA 02631
PHONE: (508) 896-4546 RBURCH@BREWSTER-MA.GOV
APPLICANT SIGNATURE
DATE
NEW MOORING PERMIT APPLICATION 20
Waiver of Responsibility
In consideration of this application being accepted, I waive and release any and all rights and claims for
personal damages against the Habormaster and the Town of Brewster. I herby absolve the Harbormaster and
Assistant Harbormater from all responsibilities of liability to myself and others or damage to an vessel,
equipment, or property. I certify that the information suppled above is the best of my knowledge and believe to
be accurate.
APPLICANT INFORMATION
NAME:
STREET:
(WINTER MAILING ADDRESS)
CITY,STATE:
ZIP:
CELL PHONE:( )
HOME PHONE: ( )
E-MAIL:
OFFICIAL USE
STICKER #
TAG#
MOORING AREA:
DATE RECEIVED:
AMOUNT PAID:
VESSEL INFORMATION
SAME (if no changes, mark same & move on)
NEW (if new vessel fill out info. Below)
Outboard Inboard Sail Other .
Vessel Name Length .
Make / Model Hull Colors .
State Reg. # .
Hull ID # .
MOORING TACKLE / LOCATION
Date last inspected / / .
Type . Weight .
Buoy type Color
PERMISSION FROM UPLAND OWNER
(Cape Cod Bay Only)
I am the upland property owner
I have written permission from upland
owner
The Town of Brewster is the upland owner
Other (explain on back)
ENGINE / PROPULSION
Type & Horsepower Make & Year
Serial Number