HomeMy WebLinkAboutAPPLICATION FOR A SWIMMING POOL PERMITCounty St. Lucie
City Port St. Lucie Zip 34952
sdowns@savannaclub. prg
ho^e7721 340-0522
Port St. Lucie
City State FL Zip 34952
St, Lucie County 77��
3. Building Department Name:_ Building Dept Carl Peterson I -r 462-1553
2300 Virginia Avenue Contact Person Phone Number
P.O. Box or Street Address Ft. Pierce, FL 34982
City, State, Zip Code
E-mail Address
4. Pool Water Source City Water Clubhouse
5. Lighting (check one): (X) No Night Swimming
( ) Outdoor. Three foot candles overhead and 1/2 watt per square foot of pool surface area underwater
( ) Indoor. Ten foot candles overhead and 8110 watt per square foot of pool surface area underwater
6. Pool Volume in Gallons: Main Pool Wading Pool Spa Pool 1 600 Other
7. Pool Bathing Load: 8 Number of Dwelling Units 1900
8. Pool Dimensions: Width: 12 rr Length- 12 r Area: 1 44 Perimeter. 48 Depth: Max. 36" Min._ Shape:
9. Water Treatment Equipment Make and Model:
(A) Recirculation Pump: StaRite
ml
s
Application Type: (check box, see instructions on back)
[ ] Initial Permit ,K ] Modification Resurface
[ ] Transfer, change of owner or name
[ ] Renewal
Department Use Only
Fee Recei;;�'.6 Date
Check# From
Operating permit# 56-60-00195
STATE OF FLORIDA SCANNED
By
DEPARTMENT OF HEALTH St. Lucie Cty
APPLICATION FOR A SWIMMING POOL OPERATING PERMIT
This original form is to be completed and submitted with one copy, a set of construction plans & specs, a copy of the building
department's final inspection along with the appropriate fee.
1. Name of Project
Savanna Club HOA
AddressofPool 3492 Crabapple Drive
2. Name of Owner
Mailing Address
Savanna Club HOA
3492 Crabapple Drive
75
5 = Jet
Flow GPM At 1 QL TDH, 5 0_ HP 1 .5
(B) Filter. Hayward
Area 325 Sq. R. Flow Capacity.
(C)Disinfection Equipment Stenner 45m5 25
Capacity (GPD) or (PPD)
(Secondary Disinfection if Applicable)
(D) pH Adjustment Feeder. Stenner 45m5
Capacity_ 25 (GPD)
(E)Test Kit:Taylor K2000
10. Equipment Substitutions
DH 4159, Eff 10/2014 (Obsoietes DH916 7/08 and DH918 5112 editions) 64E-9.001, F.A.C. Page 1 of 2
CERTIFICATION OF OWNER
The undersigned owner, or owner's repro;- , :+rtive, hereby agrees to operate the pool descriaea in this application in accordance with
the requirements of Chapter 514 of the Florida Statutes (F.S.), and Chapter 64E-9 of the Florida Administrative Code, and maintain the
original construction approved under the Florida Building Code by the jurisdictional building department. This agreement includes
keeping a daily record of the information regarding pool operation on the monthly report form furnished by the department or on other
forms approved by the department and when requested, submission of the completed form to the appropriate county health
department.A
i
C �(p Title,(a j^ r?
nt or type) dQ _Z)�_
(print or type)
REMARKS: Installing new 6"x6" Colonial Blue tile with new Depth Markers. Install
new Super Blue QuartzScapes 3/8"-1/2" thick. Bring all Main Drain Covers to
Code.
Resign Engineer/Architect Name Telephone,
Building Department Construction Approval Date Approval Number
CERTIFICATION OF INSPECTION
I hereby certify that an inspection of this pool has been made and the foregoing information is correct to the best of my knowledge and
belief. It is recommended the first annual operating permit be granted subject to the provisions of the Florida Administrative Code.
Signature DOH Engineer/Authorized Staff
Print Name
data entered into EHD by on
Instructions- Before submitting application to DOH:
For Initial Permit: Complete the entire application With owner certification. Include original and one copy of this
completed form, a copy of construction plans & specs submitted to the building department (electronic copy in PDF, TIF or
JPG format is acceptable), a copy of the building department final inspection approval, and the appropriate fee. Provide
design engineer's name and phone number in REMARKS. The operating permit number will be entered by DOH staff.
For Modification: Complete items 1 - 3, enter existing operating permit number, note proposed or completed changes in
the appropriate sections, and complete the owner certification on page 2. Include a copy of the construction plans &
specs submitted to the building department (electronic copy is acceptable) and a copy of the building department's final
inspection approval. Provide design engineer's name and phone number in REMARKS.
For Transfer: Complete items 1 and 2, enter exisfing operating permit number, then note changes in the page 2 owner
remarks section, and complete the owner certification on page 2. There is no fee or building plans required for a transfer
permit reissued due to change of ownership, name of facility, phone number, or mailing address.
For Renewal: Complete items 1 and 2, enter existing operating permit number, and complete the owner certification on
page 2. There is an annual operating permit fee charged for renewal.
DH 4159, Eff. 10114 (Obsoletes DH916 7/08 and DH918 5/12 editions) 64E-9.001, F.A.C. Page 2 of 2