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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? ___________________________  


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 requirements

2. 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


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Paid ____     Invoiced ____

Employee's Initials __________

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