Benicia, CA · Solano County
Pool Surcharge Form
Pool permit applicants use this form to describe excavation, slopes, hills, and nearby structures that may add a surcharge to a pool.
What this form is
This form helps clarify site conditions and design for a pool permit package. The contractor or owner answers questions about earth excavation, where excavated material will go, slopes or hills, and distances to nearby structures, then signs and dates the form.
Who needs it
A pool permit applicant should complete this form to clarify site conditions that could place an extra load on the pool structure.
How to submit it
Include the completed form in the pool permit package for the Development Services Department, Building Safety Division, at 250 East L Street, Benicia, CA 94510.
About notarization
This form is signed and dated without a notary; it identifies no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download the Form
Download the Pool Surcharge Form for your pool permit package.
- 2
Answer the Questions
Describe excavation, material disposal, slopes or hills, and distances to nearby structures.
- 3
Sign and Date
The contractor or owner signs the form, prints their name, and enters the date.
- 4
Include It with the Permit Package
Include the completed form in the pool permit package for the Building Safety Division.
Frequently asked questions
- What does the pool surcharge form ask?
- It asks about excavation, where excavated material will be deposited, slopes or hills, and distances between the proposed pool and nearby structures.
- Who signs the pool surcharge form?
- The form provides a signature line for the contractor or owner, along with spaces to print the signer’s name and enter the date.
- Do I need a notary for the Pool Surcharge Form?
- No. The form has a signature and date line but no notary block or notarized attachment; the contractor or owner just signs and dates it.
- How do I submit the Pool Surcharge Form?
- Include the completed form in the pool permit package for the Development Services Department, Building Safety Division, at 250 East L Street, Benicia.
Need something notarized?
This Pool Surcharge Form doesn’t need a notary — but if you have another Benicia form that does, a commissioned online notary can help.