Scribd
Upload
128 views1 page

Permit Application Operate Swimming Pool

This document is an application for a permit to operate a swimming pool in Fulton County, Georgia. It requests information about the pool owner, operator, and location. The applicant certifies that the information provided is true and correct, and agrees to comply with county ordinances regarding pool operation. The permit is non-transferable and valid until surrendered, suspended, revoked, or expired. County staff will review the application, assign a permit number and expiration date if approved, and collect any applicable fees.

Uploaded by

Patricio Orozco
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
128 views1 page

Permit Application Operate Swimming Pool

This document is an application for a permit to operate a swimming pool in Fulton County, Georgia. It requests information about the pool owner, operator, and location. The applicant certifies that the information provided is true and correct, and agrees to comply with county ordinances regarding pool operation. The permit is non-transferable and valid until surrendered, suspended, revoked, or expired. County staff will review the application, assign a permit number and expiration date if approved, and collect any applicable fees.

Uploaded by

Patricio Orozco
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
You are on page 1/ 1

APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL

Fulton County Board of Health


Environmental Health Services

Name:___________________________________________________________________________________________________
INFORMATION

Address:_________________________________________________________________________________ GA _____________
# Street Room/Suite # City Zip Code
POOL

Telephone #:_______________________ Fax#:_________________________ Email:______________________________


Pool Type:□Swimming Pool □Whirlpool □Wading □Multi-Purpose □Waterslide □Special Purpose □Spray Pool □Zero-depth
Location: □Indoor Pool □Outdoor Pool Operation: □Seasonal □Year-round Government-owned □Yes □No
________________________________ ____________________________ ______________________________
Pool Operator Name Pool Operator’s Certification # Pool Operator’s Telephone #
----------------------------------------------------------------------------------------------------------------------------- ---------------------------------
INFORMATION

Name: __________________________________________________________Title: ____________________________________


OWNER

Address:__________________________________________________________________________________________________
# Street Room/Suite # City State Zip Code

Telephone #:_____________________ Fax#:_________________________ Email:___________________________________


----------------------------------------------------------------------------------------------------------------------------- --------------------------------
Name: ___________________________________________________________________________________________________
PERMIT HOLDER
INFORMATION

Address:__________________________________________________________________________________________________
# Street Room/Suite # City State Zip Code

Work#:_________________________________________ Cell #:__________________________________________________

Telephone#:______________________ Fax#:_________________________ Email:___________________________________


-----------------------------------------------------------------------------------------------------------------------------------------------
---
INFORMATION

Name: _____________________________________________________________________________________________________________
BILLING

Address: ___________________________________________________________________________________________________________
# Street Room/Suite # City State Zip Code

Telephone #:_____________________ Fax#:________________________ Email:____________________________________


-----------------------------------------------------------------------------------------------------------------------------------------------
I, ____________________________________________________, certify that all information given in this application is true and correct to the best
Permit Holder Name (Print)

of my knowledge. The permit holder means the entity who possesses a valid permit to operate a swimming pool and is legally responsible for the
operation of the swimming pool such as the owner, agent for the owner or other such authorized or designated person. I further understand and
agree to comply with Fulton County Code of Ordinances and Code of Resolutions, Chapter 34, Health and Sanitation, Article XII, “Swimming
Pools”, as the holder of a permit to operate a swimming pool in Fulton County. If a permit is issued, it is non-transferable and is valid until it is
surrendered, suspended, revoked or expired. Preferred Contact Method: □ Telephone □ Email □ Fax

_________________________________________ _______________________________________ __________________________


Permit Holder Signature Title Date

===================================EHS Use Only====================================

Permit #: _____________ Permit Expiration Date: _____/_____/______ Service Code:_____________ District /Territory : _____/______

Fee Amount: ___________ Date of Remittance: _______/______/_______ Check/M.O. #: ______________ Receipt #: _________________

________________________________________________________________ __________________________________________________
EHS Staff Date of Issuance

You might also like