Pool & Spa Application

Department of Health · St. Joseph County, Indiana

Editable official PDF

Edit the agency’s original form, save your draft, attach documents, and review your completed PDF before signing or ordering delivery.

Print and mail service is available for your prepared packet. Review the destination and the agency’s acceptance requirements before ordering. Government payment is separate from document and postage charges.

Applicant fields are mapped to the source PDF. Agency-only fields are reserved.

Official form and instructions Pay the agency directly

Your application steps6 steps · Department of HealthView steps

1Prepare your answersComplete here
Edit and save your answers on the official PDF.
Official source
2Add supporting documentsComplete here
Attach the supporting records listed by the agency. Check that every page is legible and complete.
- Use a separate application for each pool and/or spa.
3Review and signPrepare here, finish outside
Complete each applicable applicant signature after reviewing the full declarations. Required notary, professional and witness signatures remain separate.
4Choose paymentPrepare here, finish outside
Annual pool/wading pool/spa: $155/$85/$90. Seasonal: $85/$60/$65. Government/schools: $85/$60/$65. Applicable late and mailing/processing fees are additional. Government fees are separate from the optional prepared PDF and postage. Review the exact amount and recipient before authorizing a check.
Pay the agency directly
5Submit or order deliveryPrepare here, finish outside
Use a separate application for each pool and/or spa. The original PDF is available to prepare the application. The official payment form instructs users to submit the renewal application through DocuSign first. For a paper/PDF filing, coordinate payment with the department before using that payment-only page.
Official submission instructions
6Keep your receiptComplete here
Save your agency confirmation and payment receipt. Track any mailing from My applications. Delivery does not mean the agency approved your application.

Official requirements and sources

Pool & Spa Application
Exact original PDF, applicant fields, signature blocks and printed instructions reviewed.
Official fee schedule and accepted payments
Expressly verifies check payee, mail instruments and processing charges; does not accept personal checks.
Current department fee schedule
Annual pool/wading pool/spa: $155/$85/$90. Seasonal: $85/$60/$65. Government/schools: $85/$60/$65. Applicable late and mailing/processing fees are additional.
Environmental Health current contact
Current page gives 8th Floor and mailto:envirohd@sjcindiana.gov; public phone 574-235-9750 option 6.
Department contact page
County-City Building 8th and 9th Floors, 227 West Jefferson Boulevard, South Bend IN 46601; Mishawaka office closed June 20, 2025.
Official payment-only form
Instructs payment after the DocuSign application; this page is not a substitute for submitting the application.

Complete your application

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Fill in the official form

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Revised 11/03/2025 St. Joseph County Department of Health Pool/Spa Application Permit Number: Application Date: Name of Establishment: Physical Address of Establishment: Mailing Address of Establishment: City: State Zip Business Telephone: Business Fax: Email Address: Pool Operational Hours: Establishment Owner(s): Certified Pool/Spa Operator® (CPO®): Manager/Pool Operator: Laboratory Used for Pool/Spa Water Testing: Class of Pool: Volume (Gallons): (A, B, C, or D) The following fee schedule as established by the St. Joseph County Board of Health and hereby approved by the Board of Commissioners of St. Joseph County Ordinance No. 149-22 Type of Pool Please check Only One Annual Pool: $155.00 Annual Wading Pool: $85.00 Annual Spa: $90.00 Seasonal Pool: $85.00 Seasonal Wading Pool: $60.00 Seasonal Spa: $65.00 ****Government and Schools**** Swimming Pool: $85.00 Wading Pool: $60.00 Spa: $65.00 Use a separate application for each pool and/or spa. There will be a 100% late fee for payments after April 30th. As of November 1, 2025, there is a $3.00 convenience fee to mail permits. Accepted payments; Business Checks, Money Order, Cashier’s Checks, Visa/MasterCard. In office fees will not be accepted after 4:00 p.m. ***Our office cannot accept credit card payments over the telephone. Signature Date FOR OFFICE USE ONLY Permit Fee: Employee Initial: Late Fee: Transaction No.: Convenience Fee: Date: Total:

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Review every page before signing. Professional, agency and notary signature areas stay reserved.Original blank form

Before you begin

Application checklist

Use a separate application for each pool and/or spa.

Published government feesAnnual pool/wading pool/spa: $155/$85/$90. Seasonal: $85/$60/$65. Government/schools: $85/$60/$65. Applicable late and mailing/processing fees are additional.

Annual pool/wading pool/spa: $155/$85/$90. Seasonal: $85/$60/$65. Government/schools: $85/$60/$65. Applicable late and mailing/processing fees are additional.

Current fee schedule lists $3/item mailing convenience fee and card processing fee of 2.55% or $1.55, whichever is greater; electronic checks $2 below $50,000. Confirm actual extras and applicable late charges with the office.

The form revised 11/03/2025 prints a 100% late fee after April 30 and a $3 convenience fee for mailed permits beginning November 1, 2025; confirm applicability with the office.

Printed accepted payments: business checks, money order, cashier checks, Visa/MasterCard. No fees after 4 p.m.; card payments cannot be taken over the telephone.

Current Environmental Health contact is envirohd@sjcindiana.gov; older .com addresses remain visible on some original PDFs. Confirm mailing floor before posting a packet.

Current 2026 schedule specifies 50% late fee for government/school pools; the original application has generic 100% late wording. Confirm the applicable total.

Official requirements Official source form

Source version: 2026-10-05.regional-1

Your work stays yours

Application answers and files are encrypted in private storage. Authorized service managers can review signing history and documents to process your request.