DAY ISLAND YACHT CLUB

Request for boathouse Modification    (Type or Print)

Requested by: _______________________________________ Date:______________

Address: __________________________________________ 

Phone: (Home) __________________            Phone: (Work) ___________________

Berth Number ___________________           Overall width: _____ft. _____in.

Overall Length (excluding existing bow protrusion and curtain box)  ____ ft.  ____ in.

Current overall height from water to peak    ____ ft.  ____ in.

Requested overall height from water to peak    ____ ft.  ____ in.

Start Date: ____________            Completion Date: ___________

Modifications will take place:    __ In berth  __ Launch ramp  __ Parking area  __ Guest dock

Describe Modification:    _________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(Continue on back or attach another sheet as necessary)

Port Commission Action:  Date ___________  Approved/Disapproved (Explanation)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Required Completion Date ______________

Inspection required when completed    Yes ___ No ___

Approved by: (Name): ________________________    Title: _______________________