HomeMy WebLinkAboutBest Western Permit 500006 05 26 11.JH.pdfN.0Depwtment ofEnvirownentand Natuml Resowres
Division of Enviremnental HMth
PUBLIC SWIMMING POO
OPERATION PERMIT I
Time In: 0 9 * 3 8 IE am Time Out:
11 PM - _11prn
Total Time: 1 minute
*Existing Faciffty?
Identification Wumber a 0 1 8 5 0 0 0 0 6
Old Facility ID (required if
Transifional):
Pet miission is grwited to:
H A M P T 0 N I N N
Owner or Operator of
,B,EIS,T, W,E,S,T,E,R,N,
Name of Public Swimming Poo/
to operate apublic swimming pool as defined in G.S. 130A-280 and 15A NCAC 18A.2500 at
Address 1 5 .2 0 1 3 T H A V D R S E
C ity H I C K 0 R Y ST N C zip D 8 6 0 D
I
County Catawba
TVe of Pool: (cbxck-ov_) SvVimming Pool - Seasonal SWmming Pool- Year Round
Wading Pool - Seasonal Wading Pool - Year Round
E spa - Seasonal F Spa - Year Round
Water Supply: 1-1 -Community Waste Water System: 1-1 - Community
Terrority #: 01
-Expiration Date: 1 0 / 3 1 / 2 0
Rernaiks
&I
1,17. Deparment of �nvi-onrnent and Natural Resources
Divi si cn o f Env.romnental H n1th
IRMINIM01111101 nkwemao "s
UNIN I M ONE a N
owner or Operator
2018500006
Identification Hurrit er
0512612011
Date l3sued
Status Code I
Name cf Puh-1 sc swunn xng Pool
to op erate a pub I ic swimming pool as defined in G. S , 13 OA - 28 0 and 15 A NCA C 1 SA .250 00 at
F. -M
KU V, ax M I W-1 LTA 1-11
qr'Pool Loce-tion
Type ot'Pool: (clwck one) Swimming Fool
Wading pool
Spa
Other (describe)
Signed:
r
Expiration Date;
RM
........................................... ................ .............
INSTRUCTION'S
Furpose: CTeneral Statute 13,1,k-281 states "No public smraming poet maybe opened for uq, e urd, esqs the owner or operator h,,,"q ob-,ained
an operation perinit issued by the Department", General Statute 13OA-2182 requires the Ccirmission forH@-,Ith Se'ryq to
ices
adopt roles i n d uch ag requirements for 4, p I i cat on review, ah o n, anneal, an d r e v o c an o n (, r s us pett s i on of an op e r ati ng
perant ThDse piles are curtained in 1,%k 18A , 2500
This form ;s to be used as the Fenmt specified above.
11rcp,,uatioa: Local en-uironfacatal health speci4ists shall i=ic a per-mit evef time Lq ncnw or -cisnicd pcnrmit is inlcwod. prcparc au
original and one copy for:
1. Orn�inal given to pool owne, or operator.
2, Copy for the I ocal health department.
In the evert the permittrm-sitional pertnit is su3per.ded or revoked, complete the Si-spensionfRevocatio-i fora (DEN
40j9R),
Dispositio-i: This form -n ay b e destroyed in accordance with St an &r d 83. 6.„Inspection Records, of the -Records a sposton scrxdzde
pu'Aished'Dy the N C. Division of An-Lvcs and I115tx-v,
Additional forms may be ordered from D1 V1 sl on of Environm enul Health
1632 Mail Service Cente:
Eal eigh, NC 27699-1632
(C wrier 5 2 -0 1 -00)
DF1,R 3962 (Revised 7/05)
Environmental Health Sep ces Section(R-e,,Aff-w 7/03)