HomeMy WebLinkAboutLa Quinta Pool App 500096 4 4 16.TIF 04/03/2016 21 : 12 FAX I . 1 _I1_I� n (C 0003/003
1 3 U ( No, 0046 P.� 2(�
N.C. Dcp of Environment and Natural Resources t � � J CC)
Division of Environmental Health
APPLICATION FORIPUBLIC SWIMMING POOL OPERATION PERMIT
POOL INFORMATION:
Name of public swarming pool: /q (W it:-n-2 A ,5".41-e
Street address of pool location: /6-47 Lcali y,ryi'c. C , Ed
City: Canavezr d County: _Ca lctiv a
Type of public swanning pool: (che one) ❑ Swimming pool
❑ Wading pool
Spa
El Other(describe) -
Date constructed or remodeled: (cheek one) El Before May 1, 1993
g/ Ivry 1, 1993 or later
Dates of operation: opening data Ail l SIl6 closing date //`/Sl/o
Hours of operation: opening tinaA gain! _ closing time iC/42n7
OWNER INFORMATION J �
Name of owner: (ziL" a[I / p i 4 ZL C
Mailing address: /!07, ,4" Corlov ,/1/C, 2-St(3
Contact person: feevAn/ /3WE/ Telephone: 22K-If Cr-Il o o
OPERATOR(On-Site Manager)INFORMATION:
Name of pool operator: - ark ,/ern$-n'cc6�
Address:
Telephone Number:
Pool operator trained by: (check one) El National Swimming Pool Foundation
(Certificate Number: 1
Other (please spec6) Si I h
APPLICATION SUB -t 494 p4'50cia)i
i' p
Owner or operator v flUA/1/ PATEL
Typed or pitted name
Date: 4/y/f o
Purpose;emend Stance 1304282 mull=the Commkslon for Health Sakes to adopt nJea pnnlo¢pubac ewhtunlat cols. Toe Ntee In 15A
NCAC I8A 1300 re0qqube tame or opaalnr to�lv annually far an opotadon pemdt oe mah pu6uc swiaunlrlr pool 7nls arm le In allow
ewnan or ope is of boo swimming owlet epr Thy psmite. Prgaatbm:lie 1aIDrsmnaf requoted on this f&m Is to be cnmplgtCd by the
pool owne or a daslgII S mp1 entative of the own& The COteefbe d apptiwdon le tubmittrd m the Iora1 healtlt depes ant for the runty In which
the public swimming pool is treated. A sepa t teen t m must be Retention nr each public swhmxd le pool'County/District Copks:tldaltH Health enainhlaad at
the local hW®depattnent Disposition;Pleas;re4+ to Records Retention and Disposabn Schedule for Health Depcnmr�s
which aze publlslcd by the North Carolina D9vfllon o/h istorical Rmourvca. Reotdc Addldaul fans mqy be catered horn: D th elan of
Paivhonn noel Heattlr. OcparmtentcfEnvkooneut end Natural Resource;1630 Mefl Bonito Caner,Raleigh, NC 27699-1632,(Courier$2-01-00)
DE Mm 3r9n6end(R 1eveaiseth d Sery
es Scdium(Review 4/06)
•
1-gyA -"E--N, CATAWBA COUNTY
O�r 100A SOUTHWEST BLVD
a NEWTON, NORTH CAROLINA 28658 RECEIPT
i►@ PHONE: 828.465.8399
/- �, 4- . J Friday, April 1, 2016
842 sM www.catawbacountync.gov
PAYOR: Global Hospitality Ill LLC
Global Hospitality III LLC
PAYMENTS
TRANSACTION NUMBER: TRC-647983-01-04-2016
PAYMENT DATE : 04/01/2016
PAYMENT TYPE: Check 4501
INVOICE NUMBER FEE NAME FEE AMOUNT
04-16-326789 Pool Inspection Fee - Seasonal S150.00
TOTAL PAYMENTS : $150.00
FLI-3-11-16380
CASE TYPE: Food & Lodging Institutions WORK CLASS: 50- Seasonal Swimming Pool
SITE ADDRESS: 1607 FAIRGROVE CHURCH RD SE, CONOVER NC 28613
Applicant LAQUINTA INN, 1607 FAIRGROVE CHURCH RD, CONOVER NC 28613-
Owner GLOBAL HOSPITALITY III LLC, PO BOX 1022, CONOVER NC 28613
Paid By GLOBAL HOSPITALITY III LLC, 1607 FAIRGROVE CHURCH RD, CONOVER NC 28613
**NO PEOPLESOFT ACCOUNT ASSIGNED **
receipt 04/01/2016 17:02 Page I of 1