HomeMy WebLinkAboutRidge Pointe App 500079 05 17 16.TIF FCC
N.C. Department of Environmental and Natural Resources
Division of Environmental Health 4 -zo\
APPLICATION FOR SWIMMING POOL OPERATION PERMIT
POOL INFORMATION: p
Name of public swimming pool: AVvC1R ev tcIc
Street address of pool location: \ti \V CoutCt•\\ `,Nor'
City: County: O rO V d ( 0 \.0N0
Type of public swimming pool (check one) Swimming pool
❑ Wading pool
❑ Spa
❑ Other (describe)
Date constructed or remodeled: (check one) ❑ Before May I, 1993
❑ May 1, 1993 or later
Dates of operation: opening date Iki\? Cc 0\0 closing date Se.-(1T 9.0\(s
Hours of operation: opening time CV.0 pM closing time CV.00 ?, tn.
OWNER INFORMATION:
Name of owner: 4CQ \c\ Mato l> c1S PS\\NV'u�
Mailing address: VOA Co\IA '�otet C' c Qc oJCf �C Q-C8 �
Contact person: Q�an� 0.S�� 1Agtv0,\zA J Telephone: j`d$ — 5 1 ins
OPERATOR (On-Site Manager) INFORMATION:
Name of pool operator: kk'rt' `�
Address: do �o� �nOG� S�o�O+SJ\��� \vC %(O%1
Telephone number: `\0A- ■`,$ ArY)ks
Pool operator trained by: (check one) National Swimming Pool Foundation
(Certificate Number: 00 92\a0\\
❑ Other(please.sped/i)
APPLICATION SUBMITTED BY:
Owner or operator: v-k\ � l\ge,'\ v(2\4*----
Signature Typed or printed name
Date: ?)\%s
Purpose General Statute 130A282 requires the Commission Health Services to adopt rules norcrning public swimming pools_The rules in I5:A
NCAC ISA_2500 require the owner or operator to apply annually for all operation permit titr each public swinmring pool.This tbrm is to allow
owners or operators of puhlte swimming pools to apply Ibr permits. Preparation.The intormaunn requested on this lixtn is to be completed by the
pool Owner or a designated representative of the owner.The completed application is submitted to the local health department for the county in
which the public swimming pool is located_A separate application must he completed fir each public swimming pool. Copies: Original to he
maintained at the local health department. Disposition: Please refer to Records Retention and Disposition Schedule for County/District Ilealth
Departments which are published by North Carolina Division of listnrical Resources. Reorder:Additional Forms may he ordered from: Division
of Environmental tlealth.Department of Environment and Natural Resources, 1630 Mail Service Center,Raleigh,NC 27699-1632,(0Om'Ier52-
01-00)
DENT 3961 (Revised 1/03)
Environmental health Services Section(Review 4/06)
A co CATAWBA COUNTY
�� t,y �� 100A SOUTHWEST BLVD
t NEWTON,NORTH CAROLINA 28658 RECEIPT
ate oa: ` "c4 PHONE: 828.465.8399 Tuesday, May 17, 2016
/847. sn+ www.catawbacountync.gov
PAYOR: RIDGE POINTE APARTMENT HOMES
RIDGE POINTE APARTMENT HOMES
PAYMENTS
TRANSACTION NUMBER: TRC-674209-17-05-2016
PAYMENT DATE : 05/17/2016
PAYMENT TYPE: Check 1086
INVOICE NUMBER FEE NAME FEE AMOUNT
05-16-328440 Pool Inspection Fee - Seasonal $150.00
TOTAL PAYMENTS : $150.00
FLI-0000164
CASE TYPE: Food& Lodging Institutions WORK CLASS: 50- Seasonal Swimming Pool
SITE ADDRESS: 1011 COUNTY HOME RD, CONOVER NC
OTHER-IMPORTED RIDGE POINTE APARTMENT HOMES, 1011 COUNTY HOME RD, CONOVER NC 28613
F:NONE NONE
** NO PEOPLESOFT ACCOUNT ASSIGNED **
receipt 05/17/2016 11:15 Page 1 of 1