Notification of Public Pools and Spas

To the General Manager, Coffs Harbour City Council NOTIFICATION of PUBLIC POOLS and SPA POOLS Public Health Act, Clause 35 (2) Public Health Regulation 2012, Clause 19 and 20 Locked Bag 155, Coffs Harbour 2450; DX 7559 Administrative Centre, 2 Castle Street, Coffs Harbour Email: [email protected] Phone: (02) 6648 4000 Fax: (02) 6648 4199 Website: www.coffsharbour.nsw.gov.au ABN 79 126 214 487 1. Business Owner Details

Mr Ms Mrs Dr Other: Given name/s

Surname/s

Name of company/organisation ABN or ACN (if any)

Registered business trade name (“Trading As”)

2. Billing and Contact Details

Business Owner Contact Details : Postal Address:

Suburb or town: State: Postcode:

Daytime phone: Mobile:

Email:

Nominate preferred contact method: Email Phone Mobile Postal Address

3. Extra Contact Requirements Business Owner’s Home Address:

Home Phone Number:

4. Details of Premises For Fixed Premises: Street Address:

Suburb or town: State: Postcode:

Daytime phone:

OFFICE USE ONLY Date paid: Application Receipt No: Debtor's No: fee:

Notification of Public Pools and Spa Pools [FRM- E055] 01/07/2016 5. Details of Public Pool Page 2 Number of Pool/s

Type of Treatment e.g. chlorine, bromide, ozone or other

Number of Spa/s

Type of Treatment e.g. chlorine, bromide, ozone or other

10. Applicable Fees and Charges

To view the applicable fees and charges associated with this application please refer to Council’s adopted fees and charges at www.coffsharbour.nsw.gov.au/fees

11. Privacy and Personal Information Protection Notice  This information is voluntarily required to process your request and will not be used for any other purpose without seeking your consent, or as required by law;  Your information may comprise part of a public register related to this purpose;  Your application will be retained in Council’s Records Management System and disposed of in accordance with the Local Government Disposal Authority;  Your personal information can be accessed and corrected at any time by contacting this Council. 12. Receiving Safety Updates

As part of your notification to Council you will be sent information updates and other correspondence by email from time to time. The aim of this is to keep businesses informed about key issues and updated on any legislation changes that might affect your business. Please contact Council if you have any strong objections to receiving email updates.

Notification of Public Pools and Spa Pools [FRM- E055] 01/07/2016