Reorder Additional forms may be ordered from Division of Environmental Health Department of Environment and Natural Resources 1632 Mail Service Center Raleigh NC 27699-1632 Courier 52-01-00 DENR 3961 Revised 7/05 Environmental Health Services Section Review 7/08. N*C. Department of Environment and Natural Resources Division of Environmental Health APPLICATION FOR PUBLIC SWIMMING POOL OPERATION PERMIT POOL INFORMATION Name of public swimming pool Street address of pool location City County Swimming pool Type of public swimming pool check one Wading pool Spa Other describe Date constructed or remodeled check one Before May 1 1993 May 1 1993 or later Dates of operation opening date closing date Hours of operation OWNER INFORMATION Name of owner Mailing address Telephone Contact person OPERATOR On-Site Manager INFORMATION Name of pool operator Address Telephone Number Pool operator trained by Certificate Number APPLICATION SUBMITTED BY Owner or operator Signature Typed or printed name Date....
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How to fill out the NC DENR 3961 online
Filling out the NC DENR 3961 form is an essential step for obtaining a public swimming pool operation permit in North Carolina. This guide will provide clear and detailed instructions to help you complete the form efficiently and correctly.
Follow the steps to complete the NC DENR 3961 form online.
- Select the ‘Get Form’ button to access the form and open it in the designated editor.
- Begin by filling out the pool information section, including the name of the public swimming pool, its street address, city, and county.
- In the type of public swimming pool section, select one option by checking the appropriate box for wading pool, spa, or other. If you select other, please describe the pool type.
- Indicate the date the pool was constructed or remodeled by checking the corresponding option for either 'Before May 1, 1993' or 'May 1, 1993 or later.'
- Provide the dates of operation by entering the opening and closing dates of the pool.
- Specify the hours of operation by detailing the opening and closing times.
- Move to the owner information section and enter the name of the owner, mailing address, and telephone number.
- List the contact person for the pool ownership, ensuring all contact details are accurate.
- Proceed to complete the operator (on-site manager) information, including their name, address, and telephone number.
- Enter the pool operator's training details, including the training provider and certification number.
- Identify the individual submitting the application by selecting either the owner or operator option and providing their signature, printed name, and the date.
- Review all entries for accuracy, and once confirmed, save your changes. You may also choose to download, print, or share the completed form.
Start filling out the NC DENR 3961 form online today to secure your public swimming pool operation permit.
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