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_ __ _ � , F , <br /> i <br /> , : - � <br /> �. i . <br /> .� � . i1 , .: , <br /> �,pgB7ADEPAR.TMBKTOF j For Department Use Only: <br /> r � Amaunt�ee Received$ Da#e <br /> ����� � i Check No: Fram: <br /> , <br /> ; � SP#: MF#: � <br /> � iE � - <br /> ' � � ; ST`ATE t�F FLC?F��t�A <br /> �� i� DEPARTMEI��` tJF HE�ILTH _ <br /> ,�PPLICATtC.�N FQFt APPRC�VAL QF SW11111MING F'OOL F'Lr�NS_ _ <br /> � <br /> This form is to b�compietad and submitted with.pians and specificafions in six copies along with#he appropriate fee. <br /> I � <br /> � New Constructian � _ , Revision [� Modificatian � <br /> � �'� . <br /> 1. NameofAgentorAppl�iant S?uality Inn & Suites Paol <br /> �� 6815 Gall Blvd. Pasca <br /> Address-�f Poo{: , ' i Caunty: <br /> . jl <br /> e�ty: , � zephyrhills zip; 33541 <br /> F;-_v� <br /> i <br /> 2. Name of Owner; Ja y J i va n � Phane:(81 3} 4 0 4 9 4 Q 6 Fax:( } <br /> , <br /> Mailing.Atldress: ����15 Ga11 Blvd. ��tyr;Zephyrhiils g�te; FL Z�p; 33541 <br /> � � <br /> 3. Poo!Type: Conventional � Spa� Wading � Speciai Purpose�] � Water Recreation Attraction� <br /> �, indoQr[� Duidoor x� Transient Q Non-Transient[� <br /> � � <br /> 4. Na.of ,�nits Senred: i;7 2 No,of Stasies: n j a Distance af Farthesf Unit from Pool: n j a Elevator:Yes[� No [� n j a <br /> 5. No.of Sanitary Facilities: Water Cioset Urinals Lavatories Dressing Rooms <br /> Min.I require+d Male � � Q Distance From <br /> show� � Ferimale � 1 0 PaoL• under 200 ' <br /> � � � Flex hose to rass , <br /> 6. Method of Waste Water DisposaL• g <br /> I ; <br /> 7. Poot oturrte in Gall�ns: ��, �a 0 Battting Load: � � Watar Source: Pub 1 i c , <br /> , I <br /> 8. Dimel sions:, �dth-'1 5 ' -2"Length; 2� � ��� Asea: 4 0 0 Perimeter. 8 4 Depth:Mau. 5 2 Min3 � �t: Shape:rectangl� <br /> ii <br /> 9. Type�Co�struction i41eterial: Sheli conc, �;���� marcite ��or white <br /> � .. �i <br /> 10.Equipment Make and Modei: <br /> II <br /> :{A)Recirculation Purnp: �taRite P4EA6GL Flow: ?� GPMAt �' TDH � HP 2 <br /> . �i � , <br /> � (Bj Fifter. �Pentair TR1 QO q�a: �' ��" Sg.Ft Fiaw Capacity �� <br /> , � <br /> (C)DEsinfec�on Equipmen�: Li f eguard 3 Q 0-1 9 Capacity 1 .3 GAD C] or PPD( �• <br /> �C, <br /> � (D)pN Adju 1tinent Feeder: none Capacity (GPD} <br /> � <br /> , <br /> (E}TestKit:;j Tayir�r 2005 - - , � <br /> � � <br /> , ' , _. , - <br /> � <br /> ; - . <br /> . . ji . , . , , ; , • <br /> DH 9'14,3/98{Obsoletes Sep 9Q edition) <br /> � � <br /> I <br />