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Application for Public Swimming Pool Operation Permit

Pool Information

Street Address of pool location:(Required)
Type of public swimming pool:(Required)
Date constructed or remodeled:
Opening date
Closing date
Opening date
Closing date

Owner Information

Name of owner:(Required)
Mailing Address:(Required)
Contact Person:(Required)

Operator (On-Site Manager) Information

Name of pool operator:(Required)
Address:(Required)
Pool operator trained by:(Required)

Each application must include payment of $100

Application Submitted By:

Owner or operator Signature:(Required)
Printed Name:(Required)

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