Fillable Application for Expired Permit of Mobile Home Park (Maricopa County Telecommunications)

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Application for Expired Permit of Mobile Home Park (Maricopa County Telecommunications)

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Revised October 2018 - Fillable
ENVIRONMENTAL SERVICES DEPARTMENT
501 N. 44
th
St., Suite 200
Phoenix, AZ 85008
Division of Water and Waste Management
Subdivision Infrastructure & Planning Program
Phone (602) 506-1058
Application for Expired Permit of Mobile Home Park
PLEASE PRINT CLEARLY
Project Name:
Contact Person:
Title
E-mail address of contact person
Company Name:
Phone number: Ext: Fax Number:
Address:
City: State: Zip Code:
FEES FOR MOBILE HOME PARKS
$600.---
$1200.---
$1800.---
$2400.---
(every 100 spaces add $600.)
M
CESD #_________________
NAME OF PARK
PARK ADDRESS
Owner/Manager’s Name
Mailing Address
E-Mail Address
Owner/Manager’s Signature Date
Total Spaces
Size in Acres
Section
Township
Range
Fee $
Check #
Date
Name of Water Supply
PWS #04-07-
MCESD#
Name of Sewer Utility
MCESD#
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:
(Permit Owner/Holder initials)
**It is the responsibility of the permit holder to update the Department if there is a change in contact information. **
*** The Department reserves the right to request any other information ***
Revised October 2018 - Fillable
ENVIRONMENTAL SERVICES DEPARTMENT
501 N. 44
th
St., Suite 200
Phoenix, AZ 85008
Division of Water and Waste Management
Subdivision Infrastructure & Planning Program
Phone (602) 506-1058
Application for Expired Permit of a Mobile Home Park
FOR DEPARTMENT USE ONLY
COMMENTS:_____________________________________________________________________________________
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Application for Expired Permit of Mobile Home Park (Maricopa County Telecommunications)

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Completed 6 August 2020

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