Date: ______________
Queenstown Lakes District Council
Attention: Building Services Department
I wish to notify QLDC of the existence of a pool at the following address:
AF SPN Page 1 of 1 Last Updated: 22/08/2018
Revision: 2
AF SPN-Swimming Pool Notification
Street Address: _____________________________________________________________________
Valuation Number: ___________________________________________________________________
The type of pool at my address is (please tick appropriate box):
Swimming Pool
Small Heated Pool (i.e. Spa Pool, Jacuzzi, Hot Tub) with water surface area of 5m
2
or less
The pool construction was completed on (please tick appropriate box):
OR
OR
Exact date: ________________
Approx. date: ________________
Unknown
I am/we are the (please tick appropriate box):
Owner/s OR
Tenant/s of the property
Kind regards,
Name(s): ____________________________________________________________________________
Phone No: ____________________________________________________________________________
Email Address: ____________________________________________________________________________
Signature: ____________________________________________________________________________
Once completed please email this form to swimmingpools@qldc.govt.nz
Please note there is a one-off fixed fee of $230 for registering your swimming pool with
QLDC. This fee will be invoiced to the applicant after the first inspection is completed.
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signature
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