Pool/spa Data Sheet - Sonoma County Department Of Health Services

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Sonoma County Department of Health Services
Environmental Health & Safety Section
625 5th St Santa Rosa, CA 95404
Phone (707) 565-6565  Fax (707) 565-6525 
For office use only
Date of App ________________________
ID# _________________
Dist # _______
Permit # ____________________________
Pool Contractors:
Complete and attach this form to your plans, one for each pool and/or spa. Submit spec sheets for pumps,
filters, skimmers, chemical feeders, and separation tanks.
Pool Name
Pool Address
Owner Name __________________________________________________________________________________
Phone ______________________________
Pool Contractor _______________________________________________________________________________
Phone ______________________________
Email address_________________________________________________________________________________
Type of Pool:
[ ] Standard
[ ] Spa
[ ] Wading
[ ] Special Use
Pool Size:
Depth: _______________ ft. to _______________ ft.
Estimated Total Pool Volume (Average Depth x Area x 7.48 gallons):
Shallow end to break in slope:_______________ x _______________ x _______________
Break in slope to drain:
_______________ x _______________ x _______________
Drain to end of pool:
_______________ x _______________ x _______________
Total Volume: ______________________ Surface Area _____________________________Pool Occupancy: Surface Area
= _________________
Estimated Total Spa Volume (Depth x Area x 7.48 gallons):
Bench top to surface of water:_______________ x _______________ x _______________
Spa bottom to bench top:
_______________ x _______________ x _______________
Total Volume: ______________________ Surface Area ____________________________ Spa Occupancy: Surface Area
= __________________
Coping: Bullnose ___________________________________
Other _________________________________________________________________
Permanent Markings: Lane and depth marking line, contrasting tile at edges of steps and benches (submit tile samples).
Number __________ Make & Model ________________________________ Looped or Valved separate______________________
SK Equalizers: Number __________ Pipe Size: __________ inches
Split? [
] Yes
] No
Distance apart:_________ inches
Sk Equalizer Entrapment Drain Covers: Make & Model _____________________________________ Floor [
] Wall [
] GPM Rating _______
Number __________ Make & Model _____________________________________________________ Sq Ft: ________
Revised October 4, 2011


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