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Q
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF MANSFIELD
APPLICATION FOR A PERMIT TO OPERATE A SWIMMING POOL
Application is hereby made for a permit to operate a public, semi-public, or
wading pool. This pool is to be operated according to the minimum standards
for swimming pools set forth in Article VI of the Sanitary Code of the
Commonwealth of Massachusetts.
i'1 C G. -L-- ` TEL. NO: ' r /
OWNER: f�� � -
ADDRESS: r
TOWN: /` STATE: ZIP: �' /
LOCATION -OF -POOL:/ 31 All �� � S
ADDRESS:
TYPE -OF -POOL: C -�j J �7 "�9 LENGTH: WIDTH: 3C) VOLUME:
MINIMUM/MAXIMUM DEPTHS:
SKETCH (A detailed plan must be filed with original application.)
SIZE: SWIMMING AREA: NON -SWIM AREA: DIVING_AREA:
SOURCE_ OF WATER:
DISPOSAL_ OF_SEWAGE_AND_WASTEWATER:
TYPE_ OF FINISH: C .e Yui, %� SCUM -GUTTER:
DECK_TYPE_AND_WIDTH: C _e, w9 SKIHMERS'_WEIR_LENGTH:
TREATMENT_ SYSTEM (Kind of filters, etc.):
DISINFECTION METHOD (Method, type, capacity, etc.):
CHEMICAL TREATMENT (Feeders, capacity, quantity, etc.):
REMARKS:
� Signature
Title
Date=` f
NOTE PLEASE Permit expires on December 31st yearly.
Fee is $75.00 per year, payable by check to
Torn of Mansfield, 50 ,Fest St., Mansfield 02048
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THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF MANSFIELD
BOARD OF HEALTH
APPLICATION FOR A PERMIT TO OPERATE A SWIMMING POOL
Application is hereby made for a permit to operate a public, semi-public, or
wading pool. This pool is to be operated according to the minimum standards
for swimming pools set forth in Article VI of the Sanitary Code of the
Commonwealth of Massachusetts.
1
//y�� ox�/�d�0u�`n — <�'_��-7���/7'�7`
OWNER: ^- /lv // �� / TEL. -NO:
' '� /~- '
ADDRESS.TOWN: ' � ' -STATE zip: ZIp: C)
LOCATION _OF_POOL:
/
ADDRESS:
/ ��xw^�
TYPE -OF -POOL: �^ ~ LENGTH: ^- v WIDTH:9- VOLUME-
MINIMUM/#AXIMUM DEPTHS:
SKETCH (A detailed plan must be filed with original application.)
SIZE: SWIMMING -AREA: NON -SWIM -AREA: DIVING -AREA:
f� x
SOURCE OF NATER: / ' �' '//
DISPOSAL OF SEWAGE AND WASTEWATER:
TYPE OF / FINISH: ~'°2 / SCUM GUTTER:
DECK _TYPE_AND_NIDTH: SKIMMERS'—WEIR—LENGTH:
TREATMENT -SYSTEM (Kind of filters, etc.): 3 C) )-t t/ \
� �'
DISINFECTION -METHOD (Method, type, oapncity, etc.): C_ v
CHEMICAL -TREATMENT (Feeders, capacity, quantity, etc.):
REMARKS:
Signature0-414
=�
Title
Uote_��� '^
NOTE PLEASE Permit expires on December 31st yearly.
Fee is $75.00 per year, payable by check to
Town of Mansfield, 50 West St., Mansfield 02048