HomeMy WebLinkAboutBest Western Permit 500006 05 21 14.jh.pdfNX. Mparanent of Enviroument anx) Natua�al Resoumes
DivWon of E uAronmen tal Health
PUBLIC SWIADENG POO]
OPERATION PERMIT
Time 1w 0 9 ' 5 9 am Time Out, 1 0 : 0 0 [��am
PM '_ -EIPM
Total Time: 1 minute
Pennission is granted to-.
H A M P T 0 N I N N
0 tv nor or Operator of
B E S T W E S T E R N
KAZMMZ�e
1dentifiration Nbmber 2 0 1 8 5 0 0 0 0 6
9 1 VIM A I I'Mul V
rr-
Name of Public Swimming Pool
to operate a public swinim ing 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
city H I C K 0 R Y ST N C zip D 8 6 0 D
I � �
Coun ty Catawba
Type of Pooil: (check one) *Swimming Pool -Seasonal
I Wading Pool - Seasonal
ESpa - Seasonal
to Supply:
Territory
1654
EHS I.D.
MOREMEW
K
*Expiration Date: 1 0 / 3 1
ReniaTks
HSwimming Pool- Year Roun
Wading Pool -Year Round
[:]Spa, - Year Round I
Waste Water System: 1 -1 - Commmity
Signed TW Agent
N,C, Department rat esoVces
%�4
DiNision of Envir
2 0 1 4
"N.C- Department of Enviromnent andNatur-al Resources
Di,,ision of EnNiminnental Health
2018500006
Pennission is granted to HAMPTON INN
Owner or Operator
Koji
Name ofFablic S`uimming Pool
to operate a public swirtuning pool as defined in G.S. 130A-280 and 15A NCAC 18A .2500 at
S�rwt.4 dUvw ofPoc� Location
M
Type of Pool: (check one,,,) [E Swimming Pool
Wading pool
F-1spa
E] Other (describe)
Signed: 116), , T7AA Agent
.\.C- Department f nN' na alResources
amicn of EnNi ntal
Expiration Date . 10/31/2014
Remarks -
Purpose: General Statute 130A-281 states "No public sNvirnming pool maybe opened for use unless the owner cc operator has obtained
an operation permit issued by the Department - General Statute 130A-282 requires the Commission for Health Serrices to
adopt rules includingrequirements for application re -view, expiration, renewal, and revocation or sus pensign of an operating
permit, Those rules are, contained in 15A NCAC is .2500,
This form is to be used as the pennit specified above,
Preparatiow Local emironmental health special ists shall issue a permit every, tirne a new or reissued permit is indicated- Prepare an
original and one copy for
1, Original given to pool owner or operator.
2, Copy for the local health department,
In the ment the permi t1ransitional permit is suspended or revoked, complete the Suspension,"Revocation form
4009B),
Disposition: This forna may be destroyed in accordance, i6th Standard 83 .6., Inspection Records, of the Rwords Disposifion,3cl?,edule
published by the N,C. vision of Arcluves and History,
Additional forms may be ordered from: Division of Environmental Health
1632 INtail Service Center
Rai eigh,NTC 21699-1631
(Courier 52-01-00)
DENTR 3962 (RevisM 7 05)
Emiroamental Health Smices Section (Review OS)