Facility Information
{[PNAME]}
Email
Address
Facility Name
Width (ft)
Phone #
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
(908) 665 - 2167
Fax: 908-665-9272
{[AWEBSITE]}
Facility Type
Specify Address where the pool is located.
Volume (gal)
Flow Rate (gal/min)
Depth (ft)
Length (ft)
Application Type
Turnover Rate (hrs)
ZIP
Surface Area (sq ft)
City
State
  • Contacts
  • Pool Information
  • Attachments, Fees & Certifications
Applicant Information
Address
City
Name
ZIP
Email
Who is the primary contact person for this project? e.g. the property owner, a project supervisor or site foreman.
Manager
Phone #
Phone #
Address
Organization Name
Name
Address 2
Phone #
Name
State
Applicant is Operator?
Email
Email
ZIP
Emergency Contact Information
Trained Pool Operator Information
City
State
Date Season Ends
Date Season Starts
Date of Last Sample
Certified Laboratory
Phone #
Pool Information
Type Full Name :
Sign With Hand
Preferred Payment Method
I certify that this facility will be operated in accordance with the Provisions of the Sanitary Standards of the Code of the Borough of New Providence and the Code of the State of New Jersey.
Pay By Credit Card
In order to receive your permit, you must first pay the above Application Fee.

If you'd like to pay now by Credit Card, click the Submit & Pay Now button below.

Total Fee
or
If you need to make your payment by mail or in person, our office is located at:

Borough of New Providence
360 Elkwood Avenue
New Providence, NJ 07974, (908)-665-2167

Please Attach the following Information about all Lifeguards:
  • Name
  • Phone #
  • Lifeguard Certification Completion Date
  • Lifeguard Certification Expiration Date
In order to obtain a {[PNAME]} permit, you must provide a Trained Pool Operator's Training Certificate.
Application Fee $289
Renewal Late Fees $53.00 per month will be charged if not paid by January 31
Pay Later
Signature
Application Fee
Attachments
Certification