HomeMy WebLinkAboutHampton Inn Pool App 530078 12 15 09.tif
N_C. Departrnent of Environmental and Natural Resources
Division of Environmental Health f /j) . D
APPLICATION FOR SWIMMING POOL OPERATION PERMIT
POOL INFORMATION: U
.Name of public swimming pool: 91927 ID/V[ j/y/lJ
Street address of p
pool location: 5.(~o fo~'* lw~ De. s'--c.
City ~~aw Y ~G County- _ C ;/77P OSR
;Type of public swimming pool (check one) t9'Swimming pool
❑ Wading pool
❑ Spa
❑ rther (describe)
date constructed or remodeled: (check one) p defore May 1, 1993
WMay 1, 1993 or later Lj
Dates of operation: opening date 460J6 Closing date /0
Hours of operation: opening time Closing time
OWNER INFORMATION:
Name of owner ?On/ I AJ fJ
Mailing address: 1,:Tlk pyc - 'Die, 's- e
Contact person:- V Rl e telephone:
OPERATOR (On-Site Manager) INFORMATION:
Name of pool operator. \j
Address:
(Q
Telephone number.'' Co of
Pool operator trained by: (check one) ❑ National Swimming Pool Foundation
(Certificate Number
`Other (please specify) Q') W V"Ti1^j POOL -i-.
APPLICATION SU I D 'I 0.12 t `70Cv - 6`7
Owner or ope
Signs
Typed or printed name
Date:
DENR 3961 (Revised 1OM7)
Environmental Health Services Section (Review 4199)
l l J ~~Iid rj6
~~A Cpl CATAWBA COUNTY, NC
sJ 100-A South West Blvd PERMI T RECEIPT
k Newton, NC 28658-
4+ Phone: (828)465-8399
U . oa®® '`4' Tuesday, December 15, 2009
184 sM www.catawbacountync.gov
Permit Number: FLI-12-09-3350 Invoice Number: FLI-12-09-258013
Permit Type: Food & Lodging Institutions Receipt Number: RCPT-000841
Work Class: 53 - Year-Round Swimming Pool
Address: 1956 SE 13TH AV DR, Hickory, NC
APPtiiCA'NT OWNER -
HANIPTON,INN OF, HICKORY: HAMPTON INN OF HICKORY
2258 SE HWY 70 2258 SE HWY 70 i
HICKORY NC 28602 HICKORY NC 28602
FEE DESCRIPTION DATE FEE AMOUNT
``Pool`TnsoectionFee` 12/15/2009 $2uu.uu-
TOTAL FEES $200.00
Date Payment Type Check Number Amount Change
12/15/2009 Check 010261 ' $200.00 $0.00
Memo: NCDL 2954729 EXP 6/4/11 DOES 6/4/51
Total Payment: $200.00
permit recci}~t ; ~b 161 a8c-~P_ i-s1 1 iy-o7 i 0«IJ~iSdjl I cf:.rpl 12/15/2009 08:17 Page 1 of 1