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Home My WebLink AboutApplication 2985 Ellington Road (2) Town of South Windsor — Health Department nay 1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address �p 1530 Sullivan Ave., South Windsor, CT 06074—Office Address r Phone Number: (860) 337-6173, Fax Number: (860) 644-1930 IlOS.UH,gyp.. PUBLIC SWIMMING POOL REGISTRATION FORM FACILITY NAME: S�OLl Ttf I-V/,V/J SQL v vVl In T�/r/i✓/S �/� ADDRESS: PHONE: 86© 6 41 1826 EMAIL: OWNER/ASSOCIATION REPRESENTATIVE: �� Rciy_��i✓ tiL�GSi� ADDRESS: Z 5> S %c�ryi,5t.✓ LG cw 7 Y G/T 66677P PHONE: c 60 �C''� c �� EMAIL: 13L0y -- 14/44-.SH / �qee,eC/y/ MANAGER(if different from owner): ADDRESS: PHONE NUMBER: EMAIL: POOL OPERATOR: 77.-/ ADDRESS 3/ 4i- Id1nA-12L G tic 56��7-1� l�/i�✓��S,c�'� �' % O(vG�7 PHONE NUMBER 7 Z -7 EMAIL FACILITY INFORMATION: Check all that apply: Indoor Pool Outdoor Pool X Wading Pool��Whirlpool/Spa Dates Pool is Open: From Z 7 i to 7' % Pool Capacity: i 7? Ct�C �r¢L[o�✓ Pool Make-up Water Source: Public_ Private Disinfectant Used: G°A/Z-C The undersigned agrees to com with Section 19-13-1333b of the Connecticut Public Health Code: Signature of Ap licant Title Date *Please return completed registration form to the South Windsor Health Department. Pool inspection requests must be scheduled 2 weeks prior to anticipated pool opening date.