San Juan County Public Health
             
San Juan County Health Department
735 S 200 W STE 2, Blanding, UT, 84511
Phone (435) 587-3838

*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


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:
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Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
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Billing ZIP/Postal Code:
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