Form Center

Dog Friendly Patio Permit Application (Web Form)

2. 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

4. If you need assistance, please contact us or visit one of our locations.
   Office Locations

6. 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.

8. Dog Friendly Patio Regulations
   Please review Regulation 4. Dog Friendly Patio

10. Business Name

11. Permit Number

    (if applicable)

13. Address

15. City

16. State

17. Zip Code

19. Phone Number*

20. Alternate Phone Number

22. Email Address

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

28. Animal Entrance to Patio:

30. Signage:

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

34. Patio Construction & Cleaning Procedures:

36. Dog Friendly Chemicals Being Used:

38. 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.
40. 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.
42. 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.

44. Electronic Signature

Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

* indicates a required field