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MIDLAND HEALTH and SENIOR SERVICES

 

(432) 681-7613
FAX (432) 681-7634
3303 WEST ILLINOIS, SP. 22
P.O. BOX 4905
MIDLAND, TEXAS  79704
 

APPLICATION FOR PERMIT TO OPERATE A SWIMMING POOL OR SPA IN MIDLAND, COUNTY
APPLICATION FOR EACH POOL OR SPA MUST BE SUBMITTED.

PRINT OR TYPE ALL INFORMATION

Name of Facility:________________________________________________________________________

Location:______________________________________________________________________________

Owner of Facility:_______________________________________________________________________

Mailing Address:_____________________________________________ Telephone:_________________
                          STREET/PO BOX                                          CITY/STATE/ZIP                 FAX:____________________

Manager:______________________________________________________________________________

Person Responsible for Pool Maintenance:__________________________________________________

Responsible Person has completed Pool Operators Course _______________          _______________
                                                                                                      Yes                               No

PERMIT FEE - MIDLAND CITY CODE - TITLE IV CHAPTER 5 SECTION 4 ORDINANCE #7120
                                                       $75.00 PER POOL AND $75 PER SPA

FAILURE TO OBTAIN A PERMIT BY MAY 31, 2000, WILL RESULT IN A PENALTY OF 25% OF THE APPLICABLE PERMIT FEE PLUS THE AMOUNT OTHERWISE DUE FOR A PERMIT.

The applicant hereby acknowledges an understanding of the provisions of the Ordinance relative to the payment of fees, expiration date of permit, and renewal requirements, etc.

_____________________________________________________________________________________
     Signature of Applicant                                                                                       Date

MAIL YOUR CHECK OR MONEY ORDER WITH THIS APPLICATION TO:

MIDLAND HEALTH DEPARTMENT
P.O. BOX 4905
MIDLAND, TEXAS 79704

For Health Department Use Only

Receipt Number:______________________________________ Amount:_________________________

Received By:_________________________________________ Date:____________________________