Dog Friendly Patio Permit Application (Web Form)

2. 

3. Dog Friendly Patio Permit Application

   Maricopa County Environmental Services Department <br>Environmental Health Division<br>Phone: (602)506-6824<br>esplanreview@mail.maricopa.gov

   Maricopa County Environmental Services Department
   Environmental Health Division
   Phone: (602)506-6824
   esplanreview@mail.maricopa.gov

5. The following application should be completed and returned to this Department prior to operating a Dog Friendly Patio. Approval of a Dog Friendly Patio permit will be given upon completion of a Department conducted inspection for compliance with the requirements of the Maricopa County Environmental Health Code, Chapter. VIII, § 2, Regulation 4 and U.S. FDA 2013 Food Code § 6-501.115.

7. Dog Friendly Patio Regulations

   Please review Regulation 4. Dog Friendly Patio

9. Business Name

11. Address

13. City

14. State

15. Zip Code

17. Phone Number*

18. Alternate Phone Number

20. Email Address

24. Briefly document what measures are being taken to address the following issues/concerns:

26. Animal Entrance to Patio:

28. Signage:

30. Food/Drink Preparation & Prevention of Cross-Contamination:

32. Patio Construction & Cleaning Procedures:

34. Dog Friendly Chemicals Being Used:

36. Application Agreement

    I hereby certify that the above information is correct. I have provided all relevant material requested on the application. I understand submitting this application does not guarantee my application will be approved. I understand that if the Dog Friendly Patio permit is approved, failure to follow the submitted procedures will result in a violation against my operating permit and repeated violations may result in action initiated by the Department to withdraw permission for a dog friendly patio.

    1. I agree.
38. 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.

    1. I agree.

40. Disclaimer

    Information entered on this form will be retained by Maricopa Environmental Services Department and is a record as defined by Arizona law. This form will be provided without redaction in response to a public record request unless any of the information is exempt from release under Arizona law.

    Information entered on this form will be retained by Maricopa Environmental Services Department and is a record as defined by Arizona law. This form will be provided without redaction in response to a public record request unless any of the information is exempt from release under Arizona law.

42. Electronic Signature

Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field