HomeMy WebLinkAboutBaymont Pool Permit 500098 05 23 13.gk.pdfN.0Depwtment ofEnvirommmand Natuml Resowres
Division of Enviremnental HMth
PUBLIC SWIMMING POO
OPERATION PERMIT I
Time Iri: 1 1 : 4 5 1E am Time Out: 1 2 ' 1 0 [:]am
-[RPM
minutes
Total Time:
Pet tnission is grarited, to:
B A Y M 0 N T I N N
Owner or Operator of
B A Y M 0 N T I N N
*Existing Faciffty?
Identificafion Wumber a 0 1 8 5 0 0 0 9 8
Old Facility ID (required if
"Transitional):
Name of Public Swimming Poo/
to operate a public swimm ing pool as defined in G.S. 130A-280 and 15.E NCAC 18A .2500 at
Addres-S 1 1 .2 0 1 3 T H A V E D R S E
City H I C K 0 R Y ST N C zip D 8 6 0 D
couaty Catawba
T-
ype of Pool: (check- one) FS Swimming Pool -seasonal
Wading Pool - Seasonal
nSpa - Seasonal
WaterSupply: 1-1 -Community
Territory -#-. 01
Waste Water System: 1-1 - Community
EH S I.D. 1655 Signed i( Agent
r, N,, Depar
Divisimi of EnviromentAl Healli
-Expiration Date: 0 9 / 3 0 / .2 0 1 3
1,17. Deparment of �nvr-onrnerit and Natural Resources
Divi si cn o f Env.romnental Health
2018500098
IRMINIM01111101 nkwemao "s
I AVORIM1010
o° np. r or Operator
Date l3sued
Status Code I
Name cf Piibl sc Swimn sng Pool
to operate a pub I ic swimming pool as defined in G. S , 13 OA - 28 0 and 15 A N'AC 18.E .2 5 00 at
Ir. �r, ® af. T,
rm-Usi
,"tnwL4&hvs-- qr'Pool Loce—tion
M
Type of Pool: (clwck one) Swimming Fool
Wading pool
Spa
Other (describe)
S igned: ell Agent,
NIX, Department o a ronraentaLdatual �Resouxc�es��
Di,a-i si on o f EmimrarenvA H Wth
Expiration Date; 09/30/2013
Fnrpom CTen eral Statute I -,, 1�k-us I states " ITo pubt ic miranii ng p o cl ra ay b e open e d for its e urd s q. the �)vvner or oper x or has ob-, X�i n e d
an operation permit 1squedby the Department" General Statute 130.k-282 reLlaffes the Coirmimion for HeAth Services to
adopt rules includi-ig r-quirenmts for applicaton review, �,xpitVion, mewal, an revocation or suspension of M1 operating
penant ThDse gales are cortained in 1,%k I' CC 18A , 2'5QQ
This form ;s to be, used as the Fennit specifimd above
prcpaxatioa: Locat env ironfacatal h, alth speci4ists shall iss-1c apera,it Gvcrtime anow or :6a:uodpermit is inloxod. Prepare M1
original imd one copy for:
1. Ori�inal given to pool owne, or operator.
2, Copy for the Racal health department.
In the evert the permittrm-sitional perant is swpended or revoked, complete the Suspensio-ifp'evocatioa fo-rn (DENR
40j9R),
Dispositio-i: This form -n ay b e destroyed in accordance with St an r1'r d 8.B.5., Inspection Re c ords, of the Records Lh sposk on Scxdzde
pu'Aished'Dy the N C. Division of Arr-Lvrs and IL story.
Additional forms may be ordered from D1 V1 sl on of Environmental Health
1632 Mail Service Cente:
Eal eigh, NC 27699-1632
(C wrier 5 2 -0 1 -00)
DF1,R 3962 (Remsed 7/05)
Environmental Health Sep ces Section(R-e,,Aff-, 7/03)