Andrew Linton, CPM, R.S.,
1001 N. Central Avenue
Phoenix, AZ 85004 - 1937
Kevin S. Chadwick, PE
Division Manager 1001 N. Central Avenue Suite 200 Phoenix, AZ 85004 – 1937 Fax (602) 372-0788
(Please Note: Each body of water is required to have a separate operating permit)
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.
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.
This field is not part of the form submission.
* indicates a required field