Richardson Public or Semi-Public Swimming Pool License

							                       CITY OF RICHARDSON HEALTH DEPARTMENT
                       PUBLIC/SEMI-PUBLIC SWIMMING POOL INSPECTION PROGRAM
                     P.O. Box 830309, Richardson, Texas 75083-0309  (972) 744-4080

                                  (TYPE OR PRINT ALL INFORMATION)




NAME OF FACILITY:


ADDRESS:                                                       PHONE:


FACILITY MANAGER:


MANAGEMENT COMPANY:


MAILING ADDRESS (IF DIFFERENT):


TYPE OF FACILITY:         APARTMENT                    HOTEL/MOTEL                    OTHER


DO YOU HAVE AN INDOOR POOL OR SPA?            YES       NO



TOTAL NUMBER OF POOLS AND/OR SPAS ON PROPERTY:_____________
(ALL POOLS AND SPAS MUST BE COUNTED)


FEE SCHEDULE:

                    $150.00 FOR THE FIRST SWIMMING POOL/SPA; AND
                    $ 50.00 FOR EACH ADDITIONAL SWIMMING POOL/SPA AT THE SAME LOCATION.



AMOUNT ENCLOSED: ____________



MAKE CHECK PAYABLE TO “CITY OF RICHARDSON” AND MAIL TO THE HEALTH DEPARTMENT.