Division of Building Services
Above Ground Private Permanent Pool Permit
Applicant Please Complete Items 1-9
. _________________________________________________________________2.__________________________________________________________
Address (where the pool will be located) Legal Description of Property
Owner of Record (of property) Mailing Address, City, State, Zip Phone
Contractor (Who is erecting/installing pool?) Mailing Address, City, State, Zip Phone License #
5. Pool Checklist: Valuation (Labor & Materials) $____________ Site Plan (please attach) ____
Will a new fence be needed? Yes No If existing fence: Height ___________ Fence Material/Type___________________
Will plumbing or electrical work be performed in conjunction with this swimming pool installation? Yes No
Electrical Contractor Name __________________________ Plumbing Contractor Name ______________________________
6. Applicant’s Name____________________________ 7. Applicant Phone Number____________________
8. Applicant Represents:_______________________________
Applicant Please Read
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or
local law regulating construction or the performance of construction.
9. Signature of Applicant:_________________________________________________________ Date:________________
General Conditions for Pool Approval would include, but are not limited to the following:
1. All electrical work associated with the pool is to be GFCI protected. The pool shall not be located within 22’ vertically or 10’
horizontally from overhead electrical conductors. The pool may not be located within 10’ vertically or 10’ horizontally from
overhead telephone or TV cables. Measurements are from the water’s edge. This permit does not authorize any additional
electrical work to be performed that is not directly related to the installation of the pool.
2. Enclosure of pools: Every pool with a depth of more than 24 inches (2 ft.) at any point shall be enclosed by a fence or wall
(Salina Municipal Code Sec 8-468). Every private permanent pool shall be completely enclosed by a fence or wall not less than
six (6) feet in height. The fence or wall may be solid or shall be designed so that no portion of the fence or wall would permit
the passing of a four-inch sphere through the fence or wall. The fence or wall cannot be constructed with features, which could
be used for climbing over the fence or wall. The maximum mesh size for chain link shall be 2.25-inch square. Gates must be
self-closing and must have a latch or other mechanism, which shall engage automatically upon closing.
3. The door of a dwelling which opens onto a pool enclosure will need to be equipped with an alarm.
4. Do not attach extension cords to pool equipment.
5. A copy of the “Above Ground Permanent Swimming Pool” brochure has been attached to this permit. Please read it and let us
know if you have any further questions.
------------------------------------------------------------------------STAFF USE ONLY --------------------------------------------------------------------
Application Accepted By:______________________________ Date:______________ Permit Number__________________
Approved to issue by: ____________________ Date: _________ Permit Fee _________ Date Issued:_____________
Once issued, a copy of this form will serve as your permit to do the work as described above and on the attached site plan.
Keep this permit readily available for the inspector to sign at time of final inspection and then keep in your permanent records.
Final Inspection Date: __________ Inspector’s Signature _____________________________________________________
(Inspector: Do not sign unless inspection results in an approval of all issues related to the installation / placement of this pool)
BLF 037.1 Rev. 2-2012, Rev. 5-2017
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