Davidson County Swimming Pool Operation Permit Application

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Davidson County Swimming Pool Operation Permit Application Powered By Docstoc
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                                         C. p rme t f vr me t n
                                                          o          tr l s u c s
                                        N. De a t n o En i n n a d Na u a Re o r e
                                                   vso f vr e t l at
                                                              o
                                                  Diiin o En i mn n a He lh
                                 I   ON        I     MMI             ON    T
                             APPL CATI FOR PUBL C SW I NG POOL OPERATI PERMI
               NFORMATI
          POOL I      ON:
                    I

            me f u l wi n o l
                    c
          Na o p bi s mmig p o:

           r e a d e s f o lo a i :
                                o
          Ste t d r s o p o lc t n

                                           ty
                                          Ci :                                     y
                                                                               Count:

          Ty ofpubl s mmi pool(check one)
            pe     c
                  i wi ng    :                                           mmi
                                                                       Swi ng pool
                                                                          dn o l
                                                                       W a ig p o
                                                                       Spa
                                                                               crbe)
                                                                        her(des i
                                                                       Ot
             e onsr t    emodel (che ck one )
           Dat c tuced orr    ed:                                        fr     y 19 3
                                                                       Be o e Ma 1, 9
                                                                         y 19 3 r a e
                                                                       Ma 1, 9 o lt r
             t s f p r t : p nn a e
           Da e o o e a in o e ig d t
                        o                                                       l i    e
                                                                               cosng dat
             u s f p r t : p nn i
           Ho r o o e a in o e ig t
                        o          me                                           l i i
                                                                               cosng tme
                  NFORMATI
           OW NER I      ON
             me f wn r
           Na o o e :
             in d r s :
              i
           Mal g a d e s
           Co t c p r o :
             na t e s n                                                        ephone:
                                                                             Tel
                    On-Si Manager I
           OPERATOR (   te               ON:
                                ) NFORMATI
             me f o l p r t r
           Na o p o o e a o :
             de s
           Ad r s :
             lp o e mb r
           Tee h n Nu e :
           Pooloper ortai by (che ck one )
                  at r ned :                                        t a Swi n
                                                                     o           o Fo n a i
                                                                                          o
                                                                  Na in l mmig Po l u d t n
                                                                  Ceric e
                                                                     f        :
                                                                  ( tiat Number                                           )

                                                                        eas peci
                                                                   her(pl e s f)
                                                                  Ot            t
              I   ON    TTED BY:
         -APPL CATI SUBMI
              e r p r tr
           Own ro o e a o :
                                        g tr
                                       Sina u e                          p       rnt
                                                                       Ty e d orp i e d name
                                                                    t:
                                                                  Da e
                                                                     -
             r o e Ge e a St t t OA-2 2 r q i st e Co
           Pu p s : n r l a u e 13    8 e ur he       mmiso f rHe l Se vc st a o t ue g v r ig p bi s mnig p os Th r lsi 15
                                                         s in o    ath r ie o d p r ls o e nn u l wi ic      n o l. e ue n A
                   A 2 0 e ur h wn r r p r t r o p l n u l o n p r t
                               e                                 y          o e mif r a h u l wi n o lThs o m s o l
                                                                                                c
           NCAC 18 . 5 0 r q i t e o e o o e a o t a pya n al f ra o e a in p r t o e c p bi s mmig p o. i f r i t alw        o
            wn r r p r t r f u l wi n o l o p l o e mi Pr p r t : e n o ma i e u se n hs o m s o e o lt d y h
                                  c                              s        o            o
           o e so o e a o so p bi s mmig p ost a pyf rp r t. e a a in Th if r t n r q e t d o t i f r i t b c mpe e b t e
            o l wn r r e in t d e r s n a i f h wn r Th o lt d p l t s u r ie o h o a h at e a t n f r h o n y n ih
                                           v                             c o        t                 h
           p o o e o a d sg a e r p e e t t e o t e o e . e c mpe e a pia in i s b nt d t t e lc l e l d p rme t o t e c u t i whc
           h u l wi n o ls o a e . e a a e p l t
                  c                                   c o      s b o lt d o a h u l wi n o lCo is o i n lo e it ie t
                                                                                     c                       g
           t e p bi s mmig p o i lc t d A s p r t a pia in mu t e c mpe e f re c p bi s mmig p o. pe : r ia t b man an d a
            h o a h at e a t n . s o io : e s e e o c r s t n i n
                       h                  i                              o
           t e lc l e l d p rme t Dip st n Pla e r f rt Re o d Re e t n a d Dip st n Sc e ue f rCo n yDitit at De a t n s
                                                                                s o io
                                                                                     i     hdl o               c
                                                                                                       u t/ sr He l   h p rme t
              ih r u l e y h
                        s            rh r l
           whc a e p bih d b t e No t Ca oia Diiin o Hit r a Re o r e . o d r Ad io a f r ma b o d r d fo Diiin o
                                              n                 c                        i
                                                   vso f so i l s u c s Re r e : dt n lo ms             y e r e e r m: vso f
              vr me t l at De a t n o En i me t n
                o          h                  o           t r l s u c s 16 0 iSe vc     n e , lih NC 7 9 -16 2 ( u i 2 1-0 )
           En i n n a He l , p rme t f vr n n a d Na u a Re o r e , 3 Mal r ie Ce t r Raeg , 2 6 9 3 , Co r r5 -0 0    e

                 9 1 Re ie / 3
           DENR 3 6 ( vs d 4 0 )
             vr me t l at r ie
               o          h         ci Re iw / 6
                                      o
           En i n n a He l Se vc sSe t n ( ve 4 0 )

				
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