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   Maricopa County Environmental Services Department

   Water & Waste Management Division

   301 W. Jefferson Street, STE 170

   Phoenix, AZ 85003

   Phone: (602) 506-6666

   esd.maricopa.gov | ENVsolidwaste@maricopa.gov 

   
   

   
   

   
   

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6. ADMINISTRATIVE CHANGE FORM

   SOLID WASTE OR MOBILE HOME PARK OR POTABLE WATER HAULER PERMITS

8. Permits are not transferable. If this business/location/unit has a new owner, a new permit application is required. Please contact (602) 506-6666 or visit Forms/Applications link below for more information.
   Forms/Applications
10. This form may only be used to change/update an owner mailing address, billing mailing address, or business name.
12. The Permit Owner Name refers to the entity or sole proprietor that owns the property/unit. Management Companies may not be listed as the Owner.
16. Business Information

    (If multiple permits or units are included in the change request, a supplement list may be required.)

18. Permit Number(s) *

    (Input "see list" if a supplemental permit list has been uploaded.)

20. Supplement Permit List (Excel, Word, or PDF File)
22. Permit Owner Name
24. Business/Facility Name
26. Address
28. City
29. State
30. Zip Code
34. Update / Change

    1. Owner Contact

    1. Billing Contact

    1. Inspection Contact
36. New Mailing Address
38. City
39. State
40. Zip Code
42. Contact Name or ATTN To or C/O
44. Phone Number
45. Email Address
49. Update / Change

    1. Business Name
51. New Business Name
55. Name of Requestor*
56. Title*
58. Phone Number*
59. Email Address*
Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit Submit and Print

* indicates a required field