Application for Swimming Pool Compliance Certificate

Application for Swimming Pool Compliance Certificate

This form is to be used to apply for swimming pool compliance certificate under Section 22D of the Swimming Pools Act 1992.
Applicants Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Signature of Applicant
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you the contact for Access to Perform Inspection of Premises
Location and Title Description of Property

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
LOT/Section/DP
Owner(s) Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Owner(s) Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Owner's Consent

Copy can be downloaded from the forms page - Yass Valley Council website.
Cancelof
Contact Name for Access to Perform Inspection of Premises

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Certificate of Registration

Cancelof
This application must be accompanied by a copy of the swimming pools/spas Certificate of Registration.

Swimming pools/spas can be registered by going to www.swimmingpoolregister.nsw.gov.au

Please note that this application will not be accepted without the above documentation.

The applicant is entitled to appeal to the Land and Environment Court against Council's:
1. Refusal to issue a Certificate;
2. Failure to determine the application within six (6) weeks after receipt of an application, can be deemed a refusal of the application, for the purposes of such appeal.

Application Fee

Application Fee - Swimming Pool Compliance Certificate

$150.00 AUD Quantity

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty: