Maricopa County Environmental Services Department Environmental Health DivisionPhone: (602)firstname.lastname@example.org
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.
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.
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.
This field is not part of the form submission.
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