Pool Permit Application Form - Brushy Creek MUD

Permit Instruction

This application allows for one (1) applicant only. The applicant listed below will serve as thesole primary contact for this permit.

Name of applicant

Company

Address

City

State

Zip Code

Phone Number

Cell Phone Number

Email Address

Is the project's address in an ac􀆟ve homeowner's association?

Choose one

Yes
No

If YES, did HOA approve the project?

Pick one

Yes
No

The Master Plumber must be registered and current with the District. Please see the separate Plumber Registration Application Form:

Business name

Master Plumber name

Master Plumber address

Master Plumber State

Master Plumber Zip Code

Master Plumber Phone Number

Master Plumber cell number

Master Plumber Email Address

To be included in the project

Gas to be installed by installer/others
Backflow/Auto fill

NOTE: GAS AND AUTO FILL ARE SEPARATE INSPECTIONS. IF NO INSPECTIONS ARE NEEDED, A PERMIT IS STILL REQUIRED. Requirements and re-inspection policy are listed below.

Applicant signature

Description_Fee

Application Permit Fee $66.50
Plumbing Inspection Fee $120.00

Requirements

If this pool includes auto fill or a heater, an approved backflow prevention device must be installed to manufactures recommendations. If the pool is to be filled by a water hose, a vacuum breaker must be installed on the hose bib being used to fill the pool.

An inspection must be completed by the District's inspector, listed on the permit, before filling the pool.

A set of plans showing the location of any/all of the following features:

If the prepaid plumbing inspection fails, the company listed above will be billed for all reinspections. Re-inspection fees are $120.00 each. All re-inspection fees are due within 10 days of receipt of the bill. Failure to pay re-inspection fees within the required Timeframe will result in termination from the District.

These plans must be filed with the District office

Gas Line
Auto fill device
Backflow device
Utility & Drainage Easement Locations

If access to District property is required, the homeowner must submit a Trail and Easement Access Permit Application and agreement.

Upload plans here

(These plans must be filed with the District office at the time the plumbing permit isrequested.)

Approval from Homeowner's Association is required. Approved paperwork must be provided to the District at time of application.

HOA Approval

NOTE: To ensure contamination of the public water does not occur, all backflow prevention devices must be tested upon installation and every 5 years thereafter. All backflow devices that are installed to protect against health hazards must be tested annually. This is to be done by a certified tester and a copy must be filed with Brushy Creek M.U.D. This testing will be at the home owner's expense.

Please click submit at the bottom of the page.

This section is for Office Use Only.

Office Use Only Area

Total Fees __App 50 __Insp 65

Copy ___license ___ insurance ___matches Bond List

Copy ___plans___check___receipt___permit

Issue Permit

Submit to Public Works for approval

Date Received

Receipt Number

Received By