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San Juan County Health Department
735 S 200 W STE 2, Blanding, UT, 84511
Phone (435) 587-3838
sanjuanpublichealth.org
Swimming Pool/Spa (Hot Tub) Permit
*Application and payment must be received before permit is issued*
Facility Name
Facility Address
Phone Number
Owner / Manager
Mailing Address
Phone Number
Email Address
Spa location
Indoor
Outdoor
Operating
Seasonal
Year Round
Certified Pool Operator
CPO #
Date Issued
Date Expires
**PLEASE ATTACH A COPY OF THE CERTIFIED POOL OPERATORS CERTIFICATE HERE**
Applicant agrees that maintenance of a health permit is predicated on compliance with Utah Code R392-302 (Swimming pool design, construction and operation of public pools). This permit is nontransferable and revocable for noncompliance. Permit is valid for one year from date of issue.
Signature
Date
Permit Fee:
$100.00
Item Subtotal:
$100.00
Total:
$100.00
Payment Information:
Processing Fee Rates:
Cards:
2.5% ($1.50 min)
(1.5% surcharge for foreign cards)
eCheck:
$0.75
Method of Payment:
E-Check
Update Name from Above
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
Change Payment Method
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