Village of Dering Harbor, NY
 
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Instructions

Please submit this form using any of the contact methods provided below.

Instructions
Provider Name
Village of Dering Harbor
Provider Mailing Address
PO Box 3010
23 Locust Point Road
Shelter Island Hts., NY 11965
Provider Phone
(613) 749-0020
Provider FAX
Provider Email
waterways@deringharborvillage.org

Application

Reference Number
XDUOZLGG
Application Status
Unknown
Application Phase
Other Public Access
Application Type
Mooring Permit

Applicant

Mobile Phone
First Name
Middle Name
Last Name
Contact Information
Mailing Street
Mailing City
Mailing State
Mailing Zip
Use Same Address Below
Local Street Number
Local Street Name
Local City
Local State
Local Zip Code
Primary Phone
Work Phone
Email Address
Additional Information
Are You A Resident?
Please circle one of the following:

No

Yes
Are You A Waterfront Property Owner?
Please circle one of the following:

No

Yes
Where Will Your Dinghy/Tender Be Located?
If you have entered “No” to the question “Are You A Waterfront Property Owner?”, then please indicate the location where your Dinghy/Tender will be located. If you entered “Yes”, then enter N/A.

Vessel

Reg or Doc #
Vessel Name
Vessel Type
Please circle one of the following:

None

Power

Sail
Size
Length
  feet     inches
Draft
  feet     inches
Other
Vessel Photo(s)
(Maximum file size=10MB)

Berth

Mooring Number
Location
Application Latitude/Longitude
Degrees
Minutes
Seconds
Latitude
Longitude
Show/Hide Map
Get current location from browser, if possible. If you click this and the coordinates are not updated, it is likely because you have told your browser not to share your location with us. The steps to allow access vary between browsers.
Inspection
Inspector/Installer
Please circle one of the following:

Costello Marine

Greenport Dock (Angelo)

Self

Shelter Island Ground Tackle

West Neck Mooring Service

Other (Please Specify)
Inspection Status
Not applicable
Primary Tackle
Weight Of Mooring
Float Type
Other
Distance Mooring Is from The Shoreline
Please provide coordinates or estimated distances from known points.
Float Color

Attachments

Attach a paper copy of each attachment listed below:
Proof Of Residence *
Proof Of Registration *
Expiration Date
 
Location Of Mooring *
Please attach a drawing done to scale.

Acceptance

Terms and Conditions
1. Mooring Buoys should carry the name of the owner.
2. No transferable rights are conferred as a result of the approval of the mooring locations.
3. Ever Applicant for a Mooring Permit must be either a resident or the owner of waterfront property in the Village of Dering Harbor.

I have read and understand the Online Mooring User Terms and Conditions
Signature
Date
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