Type Full Name :
Sign With Hand
Organization Name
Application Type
Property Manager
If no one is on site, how can the inspector gain access? (i.e. lockbox code, etc)
Applicant Information
Owner Type
Certification
Testing Laboratory
Required Attachments
Who is the primary contact person for this facility. e.g. the property owner, a project supervisor or site foreman.
Type of Facility
Phone #
Company Name
Name
Total fee due for this application:
State
Business Owner Information
Email
Fees
Phone #
Pool Director
Name
Name
If "Other", please specify
Name
Trained Pool Operator Information
Pool Information
Address 2
ZIP
Phone #
Phone #
Signature
Specify address where the pool is located:
Email
Testing Laboratory Phone #
Email
ZIP
Name
Pool Director Information (If Applicable)

The undersigned agrees to comply with all local, county, state and federal orders and regulations applicable to this license, and is responsible for obtaining any and all additional required approvals, permits, and licenses.

  • Licenses are not transferable to new owners or new locations.
City
Email
Pool Management Information
Email
Phone #
Public Recreational Bathing Facility License Application
Corporation or LLC Officer Information
Phone #
Type Year-Round Seasonally
Pool $250 $150
Wading Pool $250 $150
Spa $100 $75
Email

Required Documentation: The following must be included with the application or your license will not be issued:

  • Full Copy of the Aquatics Facility Plan

  • Bonding and Grounding Certificate

  • Trained Pool Operator Certificate

  • Pool Director Certification (if pool is > 2,000 ft²)

  • Lifeguard Certificates (not required for Specially Exempt Facilities)

  • Scheduled Annual Township Electric Inspection (Specify Date)

  • Passing Pool Water Analysis from a Certified Laboratory

  • Certification for the Replacement of Main Drain Covers (CB-20)

    • (Note: if not replaced since last year, please send a copy of the most recent CB-20)

  • Copy of owner/manager’s driver’s license or government ID

  • Chemical Controller System Information Form (if using in lieu of required two-hour sampling)

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Address
Phone #
Address
Contact Name
Email
Facility Information
Same as the pool management?
City
State
Emergency Contact Information