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.
Email*
example@example.com
Signature of Applicant*

Clear
Date*

MonthDayYear
Date
Are you the contact for Access to Perform Inspection of Premises

YesNo
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*

Clear
Date*

MonthDayYear
Date
Owner(s) Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Signature

Clear
Date

MonthDayYear
Date
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.
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

$165.00AUD Quantity

Total

$0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: