Form Dsss 19 - Application For A Congregate Mooring Field Permit Page 4
Download a blank fillable Form Dsss 19 - Application For A Congregate Mooring Field Permit in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Dsss 19 - Application For A Congregate Mooring Field Permit with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4I, the applicant, certify that the petitioner shall indemnify and hold harmless the state, its officers and
employees from all claims, liabilities or penalties resulting from the acts or omissions of the petitioner in
maintaining, managing or operating the mooring field:
__________________________________________________
Authorized Signature
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I , the applicant, certify that all abutters to the shore front property have been notified of this application
by certified mail, (based on municipal tax data) return receipt requested, and have been provided copies of
the application and grid map.
NOTE: Abutters: The record owner of land immediately adjacent to, and/or of any portion of land that is located
within 300 feet of, the boundaries of the proposed mooring field, including properties adjacent to the water within 300
linear feet, such as in the case of coves.
___________________________________________________________
Authorized Signature
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
The applicant hereby gives permission for the director or his agents to enter the property for the purpose
of performing a field investigation to review this application:
__________________________________________________
Authorized Signature
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
NOTE: This application may require a public hearing. The applicant and abutters will be notified as to
the date, place and time of the hearing. The Department of Safety, Division of State Police will submit a
recommendation to the Governor and Council who will approve or deny the application. The applicant
and abutters will be notified in writing of the recommendation prior to the scheduled Governor and
Council meeting.
Do not send any fee with this application. If approved, by Governor and Council, notification will be sent
requesting the decal fee. Your annual mooring decal(s) will be forwarded to you upon receipt of payment
of the current decal fee. Decals must be renewed annually and must be attached to each mooring above
the waterline prior to using the moorings. Perimeter lighting, if required, must be installed prior to
use.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I hereby certify that all statements on this application and all documentation supplied with this application
are true. Supplying false information on this application will result in revocation of any permit issued and
is punishable by imprisonment. This application is signed under penalty of unsworn falsification pursuant
to RSA 641:3.
Authorized Signature:_________________________________________ Date: _____________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business