Town of Middletown, RI
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Town of Middletown
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Application Form
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Application Completion
Instructions
Please submit this form using any of the contact methods provided below.
Instructions
1) The nearest sewage pump out facilities are located in the Stonebridge-Portsmouth Area. See map for details, at
http://www.dem.ri.gov/maps/mapfile/pumpmap.pdf
2) In case of emergency contact the Middletown Harbor Master at 401-418-1096.
3) Rhode Island is designated as a "No Discharge State" by the US Environmental Protection Agency.
Provider Name
Town of Middletown
Provider Mailing Address
Attn: Lisa Sisson
123 Valley Road
Middletown, RI 02842
Provider Phone
401.846.1144 x7076
Provider FAX
401.846.0238
Provider Email
lsisson@middletownri.com
Application
Reference Number
QDFLDJHN
Application Status
Unknown
Application Phase
Other Public Access
Application Type
Mooring Permit
Permit Type
Please circle one of the following:
Commercial
Residential
Application Comments
Applicant
Mobile Phone
First Name
Middle Name
Last Name
Suffix
Contact Information
Mailing Street
Mailing City
Mailing State
Mailing Zip
Home Phone
Home Phone (Winter)
Work Phone
Email Address
Additional Information
Emergency Contact Name
Emergency Contact Phone
Vessel
Size
Length (ft)
feet
inches
Other
Vessel Photo(s)
(Maximum file size=10MB)
Wait List
Wait List Selection
List Name
# Berths
Mooring
0
Berth
Inspection
Seasonal Status
Location
Location on Application
Degrees
Minutes
Seconds
Latitude
Longitude
Acceptance
Terms and Conditions
All information I am providing is correct to the best of my knowledge.
I have read and understand the Online Mooring
User Terms and Conditions
Signature
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