Application Form
Swimming Pool Certificate of Compliance
PO Box 183 Section 22D Swimming Pools Act 1992
Camden NSW 2570
02 4654 7777
Receipt No Receipt Date Fee Paid $ Application No.
Location Address of Swimming Pool
Unit/Street No Street Name
Suburb Post Code
Lot No DP/SP No
Purpose for application for Certificate of Compliance
Sale of property:
Lease of property:
Other: Please specify: ………………………………………………………………
Approximate year the swimming pool was approved/constructed…………………………………..
Development/Building Application number (if known):………………………………………………..
Type of swimming pool: In-ground Semi in-ground Above ground Spa/Hot Tub SwimSpa
Construction materials Concrete Fibreglass Metal Other………………………..
Has the swimming pool barrier/fence (including boundary fences) been modified since original construction of
the swimming pool? Yes
No
If yes, approximate year of modifications:………………………..
Does the swimming pool barrier/fence incorporate any glass panels? Yes No
If yes, certification from a Glazier will need to be provided prior to the issue of any Certificate of Compliance.
NSW Swimming Pool Register No……………
(NB Pool must be Registered to apply for a certificate)
Applicant Details / Owners Consent (Note: must be the owner of the land)
Title Given Name Family Name
Organisation/Company
Address
Contact Phone Number Email Address
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