HomeMy WebLinkAboutApplication Cinnamon Springs Road Town of South Windsor — Health Department
1540 Sullivan Ave., South Windsor, CT 06074- Mailing Address
1530 Sullivan Ave., South Windsor, CT 06074-Office Address
=+ Phone Number: (860) 337-6173, Fax Number: (860) 644-1930
PUBLIC SWIMMING POOL REGISTRATION FORM
FACILITY NAME: C, o nJ 7�b M=A1TyM A7 `ZN^I R A^*4 SPRiAiGs Asoco-P&A),lyk
ADDRESS $4112ln1Gs smrdw+ W"/65a(' ex 66oji`f
PHONE: $0 "5;Lb - 2-8$.5' Y. 4011 EMAIL: "h osre7t @ wtsraccye�vhGr•�o�•
OWNERIASSOCIATION
REPRESENTATIVE: WtSTr-ai D ReA, (�-ST,4-i7 rw��/AteritExT, u.0
ADDRESS 3Y 8 �rrapao T�/►4 vPrKF• -1-r 1-0 f Vl-;TNB✓V 1 CT O L
PHONE: $W -5;?8" 7,02),5K ` ()l EMAIL: MCOS7ek A ideSryqy2D MG7.ewt \
MANAGER(if different from owner):
ADDRESS t -A -ifz*b 1Vk,40k-6 $U17 7Loa �i/�`RMyyt� , CT 1060t
PHONE NUMBER: 600-152_0`7P>KX q04 EMAIL: fV^c4srm, @ cj.E mm Y Cwh
POOL
OPERATOR: S PL.0 4
ADDRESS I034 -JD" V-71TCA 13LID , 5W7-P, W 1r-1D ScA,,L'T 6604
PHONE NUMBER 40 ":26A - I bZ� EMAIL FSQrjibA j SA.Ai40&ec-,siLp� ,CoA-
FACILITY INFORMATION:
Check all that apply: j
Indoor Pool Outdoor Pool Wading Pool Whirlpool/Spa
Dates Pool is Open From MPrJ 21 � :�411 to
Pool Capacity:
Pool Make-up Water Source Public ✓ Private
Disinfectant Used: C"ag1^fr
The undersigned agrees to comply with Section 19-13-1333b of the Connecticut Public Health Code:
Signature of Applicant Title Date
RECEIVED
'Please return completed registration form to the South Windsor Health Department Pool inspection requests mast DCU tiled 2 weeks
prior to anticipated pool opening date.
SOUTH HEALTHIDEPT.