Form 22 - Regulation 147P(1) - Application to Register a Swimming Pool / Spa

Name of owner of the land on which the swimming pool / spa is located*

First Name

Last Name

Owner Postal Address*

Address Line 1

Address Line 2

City

State

Postcode

Phone*

Email*

Pool / Spa Location Address (if different from above)

Address Line 1

Address Line 2

City

State

Postcode

Title Details (if known) - e.g. Crown allotment, Lot number, LP/PS, Volume, Folio, Section, Parish

Pool / Spa Type*

In-ground Above Ground - Permanent Above Ground - Relocatable Inflatable / Temporary (*3 days +) Spa - Permanent Spa - Relocatable

Pool / Spa Installation Date (if known)

Was a Building Permit obtained? (please provide copies of any relevant building permit if available and/or any other information or documentation that provides evidence of when the swimming pool or spa was constructed)*

Yes No Unknown

If Yes, Date of Building Permit

Building Permit Number (if known)

Building Permit Issued By (if known)

Municipal Building Surveyor Private Building Surveyor

Provide a copy of Certificate of Final Inspection No File Chosen

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Other relevant documents (if any) No File Chosen

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Other relevant documents (if any) No File Chosen

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Has there been any other building work that has altered or resulted in changes to the barrier since the swimming pool / spa was constructed or erected?*

Yes No Unknown

If yes, please provide details and copies of any relevant building permit or other documentation

Signature*

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Use your mouse or finger to draw your signature above

We respect your privacy. We will not sell or give away your personal information, unless required by law. Occasionally, we may use your details for our own research purposes or to let you know about other council information. If you want to see your personal data, modify your details, or if you receive information from us you do not want in the future, please contact 1300 520 520.