HomeMy WebLinkAboutHickory Trace East Permit 500090 05 18 17N.C. seaman ofEmdmemmr aed Namnl Rmar m
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PUBLIC SWIMMING POOL
OPERATION PERMIT
'Update Existing Facility?
New Fa HWHD: 1 0 1 8 5 0 0 0 9 0
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Tans In:0 1: a 5 Opm T.ne ac a: 1 i ®pm 'Date Issued 0 5/ 1 8 / a 0 1 7
T04 Tyne: 0 Minutes 'Status Code: I
Permission is granted to
P R O F E S S I O N
A L R E
A
L T Y M N G T I N C
owner or 6peietoiof
H I C K O R Y T R
A C E E
A
S T
Name otPuelie Swimming Pool
to operate a public swimming pool
as defined is G.S.
130A-280 and 15A NCAC 18A.2500 at
Address 1 1 6 0 5 T
H 5 T
N
E
city H I C K O R Y
County 1 8
Type of Pool: (check one) BSwimming Pool -Seasonal
Wading Pool -Seasonal
Spa - Seasonal
Specialized - Seasonal
Water SuppY ss- menideescanmeniy
Territory #: 01
ST N C zip 1 8 6 0 1
H
Swimming Pool -Year Round
Wading Pool -Year Round
Spa -Year Round
Specialized - Year Round
Waste Water System: as-tdnnoeauc nky
EHS: 1958-Keln,nmg Signed ��`Q ^US Agent
N.C. Dyamm� of Ev�immm� and V vwal Femm¢s
Diwtlm otEeuiw®mW HdN
-Expiration Date: 0 9/ 1 9 /.1 0 1 7
Remeha
4000
N.C. Depmman aEaxtmmmtamNm,a aemmm
2018500090
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Nmtifiatim Nu�u
PUBLIC SWIMMING POOL
05/18/2017
Danlaaa
OPERATION PERMIT
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Pemtission is granted to PROFESSIONAL REALTY of HICKORY TRACE EAST
V114" rom or opamw Name ofPudlc Slvimminglnool
to opefate a public swimming pool as defined in G.S. I3GA-280 and 15A NCAC 18A.2500 at
1260 5TH ST NE, HICKORY, NC 28601
SnmtAddessofPod Docrion
18
County
Type of Pool: (check one) ® Swimming Pool
Wading pool
Spa
Specialized
Other (describe)
Signed: f J 1 L S Agent
N.C. DepamensoPF 'rmmmtmdN9tma Fammw
Diaiim aEevtmmmtalHWn
Expiration Date: 09/29/2017
Remarks:
-----------------------------------------------------------------------------
MaMUCnors
purpose: Genual Stamm 130A-281 sores- No public smnning pool may be opmedfee use unless the oeon or opesor has opined
an opaadm pewit issued by the Detmmene. Geneses Statute 130A-282 requve the Cm®issim for Health Smiees to
adopt roes Including «wuments for application review, expiration, renewal, mdrewcmm or susmsom clan opesafing
penisthose rules n contained in 15A NCAC 18A 5500.
This ram is to beused as the peont spasmed ahove.
Isre5raim: Localen rmnwtal hedth speients shat issue a penis every fine a new or restated pewit is indcrei 14epesem
oriental and me cWy for.
1. Original gives to pod omaor opuata.
2. Capt for the local head, depament
In the event thepamitrtranitimal most is mspmdW orrmokM mndete the SaspmimrRmomim time (DEM
4009B).
Disposition This form may be destroyed in«msd3a<e wish smoked 82 C. InmaHm Roads. dthe Rscv s Disposioon&Amisle
NtAished by the N C. Division d&chives and fbmay.
Adidmal forms wry beordesedfim: Mvidm d Enr%mmannl Fled,
1632 Mil Service Corsa
Biigh, NC 27699-1632
(Gies 52L1(�
EH 3962( sed 7N5)
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