Division of Building Services
Private Above Ground Seasonal Pool Permit
Applicant Please Complete Items 1-8
. _________________________________________________________________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 will install/erect pool?) Mailing Address, City, State, Zip Phone License #
5. Pool Checklist: Site Plan (please attach) ____ Do you own and occupy the home? YES No
Do you rent the home? Yes No Tenant Name: ___________________________________________
If you rent your home, submit written approval (to have a pool) from the landlord/property owner? Yes No
Will a new fence be needed? Yes No If fence is existing: Height of fence? _____ Fence Material/Type: ______________
Will electrical work be performed in conjunction with pool installation? Yes No Electrical Contr. Name _______________
6. Applicant’s Name____________________________ 7. Applicant Phone Number_________________
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.
8. Signature of Applicant:_________________________________________________________ Date:________________
Staff use only
Application Accepted By:______________________________ Date:______________ Permit Number__________________
(Staff Signature)
Approved By: _____________________ Date: _________ Permit Fee _________Receipt Number_________ Date Issued:________
(Staff Signature)
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 24 inches or more at any point shall be enclosed by a fence or wall (Salina
Municipal Code Sec 8-468). Private seasonal pools shall be completely enclosed by a substantial fence or wall not less than 48
inches 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. Do not attach extension cords to pool equipment.
4. Once a permit is approved for a seasonal swimming pool you are not required to renew the permit as long as: 1) The pool remains at
the same physical address. 2) The pool is placed in the same approved location, based on the approved site plan on file. 3) The pool
is not replaced with a different pool of greater depth or size.
5. A copy of the “Seasonal Swimming Pools” brochure is attached. Please read it and let us know if you have any further questions.
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 037.2 Rev. 7/2017
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