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  1. Steven Goode, R.E.H.S., M.A,
    1001 N. Central Avenue
    Suite 400
    Phoenix, AZ 85004 - 1937

  2. Maricopa County seal

  3. Kevin S. Chadwick, PE
    Division Manager
    1001 N. Central Avenue
    Suite 200
    Phoenix, AZ 85004 – 1937
    Fax (602) 372-0788

  4. (Please Note: Each body of water is required to have a separate operating permit)

  5. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  6. Inspection Report Receipt Agreement*

    Pursuant to A.R.S. § 41-1009, the Department may enter your establishment to conduct inspections. You have the right to receive a copy of the Department’s inspection report at the time of the inspection, within thirty (30) days after the inspection, or as otherwise provided by federal law. By initialing below, I agree that the Department may send me a copy of its inspection report by e-mail to the following email address or by facsimile transmission to the following fax number. It is the responsibility of the permit holder to update the Department if there is a change in contact information.

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  8. This field is not part of the form submission.