HomeMy WebLinkAbout29 North Pool Permit 500101 05 16 14.ls.pdfN.C. Department ofluvikonment and Natural Resources
Di"4on, of Environmental HeaM
PUBLIC SWINMING POO
OPERATION PERMIT I
[Eam Mam
Time In: 0 7 ' 4 8 [] PM Time Out: 7 : 5 0 EIPM
Total Tirne° 2 minutes
idtatification NumbeT 2 0 1 8 5 0 0 1 0 1
Pennission is granted to:
a 9 N 0 R T H A P A R T M E N T
0 tv ner or Operator of
12 9 N 0 R T H A P A R T M E N T S
I
W§��M
Name of Public Swimming Pool
to operate a public swinim in g pool as defined in G.S. 13OA-280 and 15A NCAC 18A .2500 at
Address 1 1 4 .2 9 T E -'A 11 E D R I T E 11
C ity H I C K 0 R Y ST N C zjp D 8 6 0 1
County Catawba
Type of Pool: (check ones Swimming Pool - Seasonal
Wading Pool - Seasonal
E Spa - Seasonal
to Supply: i-1 -Community
Territory #: 01
i M.
MM
*Expiration Date:
Remaiks
M
Swimming Pool- Year Roun
.:Wading Pool - Year Round
—Spa -Year Round I
Waste Water System: 1 -1 - Commmity
N-C. Department ofEnvi-amnemt and Natural Resaurces
Di-visicnofEnv,ronmentat Heailth
2018500101
49019 M 11 V I I ; F-41 V. a :4 11 M I q- 0
Owner or OptTaror
Date 15sued
Status C CA,— I
to operate a public sm-imming pool as defined in GmS. 130A-280 and 15A, NCAC 18A .2500 at
M! r
Type of Pool: (check ow) Swimming Pool
W adi ng pool
Spa
Other (describe)
Sighted: Agent
anir WO
ealof I Rmor R.
o -wironzrtntal Health)
Expiiatj(mDatc� 10,/D4/2014
114'1 1511111111
MMIUM, a
Imn9m
PUrPOse: Gen eras Statute 13 )A-2 8 1 states ""No public smimmi rag poel may Lye open e d, for us e uni -,;s the owner cc operater has otx ain ed
,operation penalit issued by the Depzrtanent", General Statute 130A-292 require-, the Ccmmi ssion for Health Senices do
adopt rules iriducfiag r-.,quir=, eats for applicators resiew, expi:,ation, rmexval, andrevocation or sus Msiorrof an operrafing
pearnit, Those :wiles arc corAzanedia 0AINCA, C ISA-150Q,
Tins form �s to he used as thpenuit specified above.
prcparztio-a_ Local eneironmmatal health specialists "I issue a Permit every tinac, a new or fcis=.ued pelmet is ilizficaled- Preparcan
original and, one copy for:
1. Original given to pool owner or operator,
2.. on, for the local health deparitment.
In the --vent thpenarittransitional permit is suspended or ro,,oked, complete the. Suspension.>Rtvocaticsi tonal kDEI�a
40'1`411).
Dispositioa: T hi s, form maybe de stro y ed in actor dm, c e ,vi t h Standard 8. B . & ; I n spect i on Records, of the R ecorris D i pos 2 ti o n &,hedade
pulb,fished'ay the N,.C,, Division of A-i dulvc5 an'A 111story-
Additional forms m—ky be ordered frorn DiNi sion of Environmental Health
163,2NUI Service ctnttm-
Raleigh, NC27649-1632
(Courier 52-01-OG)
DENTR 3962 (lReeised 7,05)
Emit-mmental Health �ices Sectim (Rt,6!w TOB)