Fillable Approval of a Mobile Home Park Packet (Maricopa County Telecommunications)

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Approval of a Mobile Home Park Packet (Maricopa County Telecommunications)

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Revised October 2018
Maricopa County
Environmental Services
Approval of a Mobile Home
Park Packet
Mailing and Delivery Address:
Maricopa County Environmental Services Department
Subdivision Infrastructure and Planning Program
501 N. 44
th
St., Suite 200 / Phoenix, AZ 85008
For the Use of New Construction of a Park or Addition of Spaces
COVER / TRANSMITTAL PAGE
Fees for the approval of a mobile home park are separate from the fees for the approval to construct the water/sewer lines.
Su
bmittal process:
1) Submit Mobile Home Park application.
2) For New Parks or additions to existing parks, submit ATC application for new water/sewer infrastructure.
3) Once ATCs have been approved, the Mobile Home Park application will be approved.
4) Once water/sewer lines are constructed AND before use of park, the AOCs must be submitted to MCESD.
Fo
r the regulations regarding mobile home parks, please see:
• The Arizona Administrative Code, Department of Health Services-Food, Recreational and Institutional Sanitation,
Title 9, Chapter 8, Articles 3 – 8 and
• The Maricopa County Health Code Chapter IX – Trailer Coach
(Mobile Home) Parks Sections 1 – 9.
Project Name:
(PLEASE PRINT CLEARLY)
Contact Person:
Title
E-mail address of contact person
Company Name:
Phone number:
Ext: Fax Number:
City: State
Zip
Code:
FEES FOR MOBILE HOME PARKS
$600.-----
---100 spaces or less
$1200.-----
---101 to 200 spaces
$1800.-----
---201 to 300 spaces
$2400.-----
---301 to 400 spaces
(every 100 spaces add $600.)
To Expedite A Project -- Double The Fee
A ny S i gna t u r e s C a nn o t B e Mo r e T ha n O n e ( 1 ) Y ea r O l d .
A
ny questions contact Cindy Furze at 602-506-1058 or CFurze@Maricopa.gov
*** The Department reserves the right to request any other information ***
Visit our web page at www.maricopa.gov/EnvSvc/WaterWaste/Subdivisions/Subdivisions.aspx
Revised June 2012
Maricopa County
Environmental Services Department
Water and Waste Management Division
501 N 44
th
Str., Suite 200
Phoenix, Arizona 85008
Phone: (602) 506-1058
www.maricopa.gov/envsvc
P
ERMIT APPLICATION PROCESS NOTICE
Subdivision Infrastructure and Planning Program
1) Steps required to obtain a Sanitary Facilities for Subdivision (aka Health Cert)/Approval of a Mobile
H
ome Park are as follows:
i) Submission of the complete application for Sanitary Facilities for Subdivision/Approval of a
Mobile Home Park along with all relative items in the application check list on the
Cover/Transmittal Page of the application.
ii) The submittal will be reviewed/additional information may be requested.
iii) The Approval of Sanitary Facilities for Subdivision/Mobile Home Park will be issued.
2) T
he Department will approve or deny the application in the number of business days listed below or less,
excluding any days the application is returned to the applicant for additional information. This overa
ll
l
icensing timeframe is set by the Arizona Department of Environmental Quality (ADEQ) as required by
A.R.S. §11-1605 and is part of the Delegation agreement between ADEQ and Maricopa county.
Permit
Overall Timeframe (Business Days)
Subdivision
Individual water/sewer facilities
67
Community water/sewer facilities
58
Mobile Home Park
Onsite water/sewer facilities
67
Offsite water/sewer facilities
58
3) Department contact information regarding your application
i) Telephone: 602-506-1058
ii) E-mail: subdivision@mail.maricopa.gov
iii) Website: www.maricopa.gov/EnvSvc/WaterWaste
4) Y
ou may request a clarification from the Department of its interpretation or application of a statute,
ordinance, regulation, delegation agreement or authorized substantive policy statement as provided in
A.R.S. §11-1609. Contact us by e-mail or telephone, or in person or mail at the address listed at the top of
the page, marked attention Subdivision Infrastructure & Planning Program.
Revised June 2012
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 Approval of a Mobile Home Park
MCESD #_________________________
GENERAL DATA:
NEW
ADDITION
NAME OF PARK
PARK ADDRESS
Engineer Of Project
Name Firm
Engineer’s Mailing Address
Engineer’s E-Mail Address
Owner/Manager’s Name
Mailing Address
Owner/Manager’s E-Mail Address
Owner/Manager’s Signature
Date
Dependent Park - New Spaces
Existing Spaces
Independent Park - New Spaces
Existing Spaces
Total New and Existing Spaces
Size in Acres
Section
Township
Range
Fee $
Check #
Date
Name of Water Supply
PWS #04-07-
MCESD#
Name of Sewer Utility
MCESD#
WATER SUPPLY AND SEWERAGE SYSTEM DATA
(Submit 3 copies of project plans and specifications for Department Approval prior to construction.)
I
WATER SUPPLY SYSTEM –
New System Extension of Existing System
The following data must be submitted:
1. The completed form “Application for Approval To Construct”
2. Water Service Agreement (If service is from an existing system)
II
SEWERAGE SYSTEM – Liquid Waste Disposal will be by (Check one)
Individual septic tanks
Community septic tank(s) (Provide ambient groundwater nitrate level ___________ mg/l)
Common collection sewers with a central sewage treatment facility (submit Application of Approval to Construct)
Common collection sewers discharging into an existing sewer system (submit Application of Approval to Construct)
(Provide A Sewer Service Agreement
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 June 2012
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 Approval of a Mobile Home Park
FOR DEPARTMENT USE ONLY
PLAN REVIEW
DISAPPROVED DATE_____________INITIALS_______ APPROVED DATE___________________INITIALS_______
CONSTRUCTION INSPECTION
WATER SYSTEM
DISAPPROVED DATE_____________INITIALS_______ APPROVED DATE___________________INITIALS_______
SEWER SYSTEM
DISAPPROVED DATE_____________INITIALS_______ APPROVED DATE___________________INITIALS_______
FINAL INSPECTION
WATER SYSTEM
DISAPPROVED DATE_____________INITIALS_______ APPROVED DATE___________________INITIALS_______
SEWER SYSTEM
DISAPPROVED DATE_____________INITIALS_______ APPROVED DATE___________________INITIALS_______
GENERAL LAYOUT
DISAPPROVED DATE_____________INITIALS_______ APPROVED DATE___________________INITIALS_______
Date Filed: ___________________ SEC.__________ T________ R_________
COMMENTS:____________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Revised June 2012
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
Water / Wastewater Service Agreements Page
This agreement MUST be signed by the Providers NOT the Engineer or Project owner.
WATER SERVICE AGREEMENT - An unconditional agreement which is effective this date has been made
between the owners of:
Mobile Home Park Name
and the
(Name Of The Water System Or Municipality)
to provide water service to each and every lot in accordance with the design shown on the attached plans of
the mobile home park.
The undersigned hereby agrees to inspect this project during construction to assure compliance with plans
and specifications approved by the Maricopa County Environmental Services Department (MCESD) and
upon completion and acceptance by MCESD shall be responsible for maintenance and operation of the
system.
Date
Print Name clearly
Job Title
Address
City
Signature
This agreement MUST be signed by the Providers NOT the Engineer or Project owner.
SEWER SERVICE AGREEMENT - An unconditional agreement has been made between the owner/s of:
Mobile Home Park Name
and the
(Name Of The Sewer System Or Municipality)
to provide sewer service to each and every lot in accordance with the design shown on the attached plans of
the mobile home park.
The undersigned hereby agrees to inspect this project during construction to assure compliance with plans
and specifications approved by the Maricopa County Environmental Services Department (MCESD) and upon
completion and acceptance by MCESD shall be responsible for maintenance and operation of the system.
Date
Print Name clearly
Job Title
Address
City
Signature
Revised June 2012
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
Refuse Service and Disposal Agreements Page
This agreement MUST be signed by the Providers NOT the Engineer or Project owner.
REFUSE SERVICE AGREEMENT - Agreements must be completed and signed by a representative of the
collection service and the operational authority of the disposal site
:
Collection Agency
Refuse collection service to
(Name of the Mobile Home Park)
in accordance with applicable rules and regulations governing refuse collection.
Date
Print Name clearly
Job Title
Address
City
Signature
In Order To Approve The Above Collection Service, We Must Also Have The Information In The Agreement Below.
This agreement MUST be signed by the Providers NOT the Engineer or Project owner.
REFUSE DISPOSAL AGREEMENT - As required by the Arizona Department of Environmental Quality Rules
and Regulations, and specifically regulation A.A.C. R18-5-409:
The Disposal Site
is operated by
(Name of Operational Authority)
in accordance with applicable rules and regulations governing refuse and will accept refuse from persons living in:
Name of Mobile Home Park:
Date Print Name clearly
Job Title
Address
City
Signature
The signatures cannot be more then 1 (one) year old.
IF YOUR PROJECT IS IN THE CITY OF PHOENIX – Mobile Home Park Refuse Agreement must be signed by
the City of Phoenix. No Exceptions.
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Approval of a Mobile Home Park Packet (Maricopa County Telecommunications)

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Completed 6 August 2020

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