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Application to install a swimming pool
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Village of Atholville
247 Notre Dame St.
Atholville, NB E3N 4T1
Tel: (506)789-2944 fax: (506) 789-2925
Application to install a swimming pool
Pool location: ____________________________________________________ Applicant's name: _________________________________________________ Applicant's phone number: __________________________________________ Do you own ___ or rent ___ If you are renting, name of owner: ____________________________________ Owner's address: ________________________________________________ Owner's phone number: ___________________________________________
Swimming pool information
Size of Pool: ________ X ________ OR Diameter ________ Height: ________ Permanent installation ___ yes ___ no Water capacity (80%) _________________ Where, on your land, will the pool be installed? ___________________________ DECLARATION
I, _____________________ of ___________________in ht county of _______________________ do solemnly declare:
1. THAT I hereby request a permision to install a pool as described, and agree
to conform to all by-laws and pertinent administration requirements2. THAT I am owner (or authorized agent) named in the above application.
3. THAT the declarations contained herein are completely true and made with
full knowledge of all circumstances connected therewith.AND I make this solemn declaration sincerely believing that it is true and that
it has the same effect as if had been solemnly sworn under the
"Canada Evidence Act".Sign at ________________________ on this ____ day of ____________ 20__. __________________________________
Signature of applicant
For office use only
Paid ____ Invoiced ____
Employee's Initials __________
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