Waco-McLennan Pool and Spa Permit Application by PermitDocsPrivate


									                       Waco-McLennan County Public Health District
                             Environmental Health Division
                              201 W. Waco Dr. Room 205
                                   Waco, TX 76707
                                    (254) 750-5464
                                 Application for Pool/Spa Permit
Application is hereby made for a permit to operate a public or semi-public swimming pool or
spa. By this application it is agreed that the permit holder, its representative, and applicant will
comply with the local city ordinances including supervision, maintenance, operation, and safety
of the pool or spa. It is further agreed that inspectors of the Health District are authorized and
empowered to enter upon and make inspections of the premises of the permit holder while the
pool or spa is in operation or use and at any other reasonable time.
Name of Establishment:__________________________________________________________

Applicant’s Name (Print):________________________________________________________

Person Responsible:_______________________________________                            Title:_____________

Name of Corporation (if applicable):________________________________________________

                                 (Include street, inside the city limits of which city, and zip code)

Mailing Address:________________________________________________________________
                                 (Include street, city, state and zip code)

Phone Number:_________________________ Emergency Number:______________________

Number of:       Pool:___________         Spa:___________              Wading Pool:___________

Pool Operator:__________________________________________________________________

Operating Season:_______________________________________________________________
Upon receipt of this application and payment of fee, the Health District shall inspect the facilities
to determine compliance with the provisions of applicable regulations. When in compliance, a
permit shall be issued to the applicant. Said permit shall be valid for one year unless revoked or
suspended. Operating without a valid permit is a violation of city ordinance.

The Waco-McLennan County Public Health District is an Equal Opportunity Employer and is prohibited from
discriminating on the basis of race, gender, color, religion, national origin, age, or disability.

_______________________                             _____________________________________
Date of application                                 Signature

S:\Health Exchange\Environmental Health\application for pool&spa permit.doc               Revised 6/05
                                 Office Use Only

S:\Health Exchange\Environmental Health\application for pool&spa permit.doc   Revised 6/05

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