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2. Owner Name*
4. Project Address/Cross Streets*
6. City
7. Maricopa County Environmental Services Division Number*
9. Contact Name*
10. Phone Number*
12. Email Address*
13. Fax Number
15. Type of Inspection*

    1. Final Construction Inspection
    2. Final Construction Partial Inspection

    1. Abandonment/Closure Inspection
    2. Final Construction Re-Inspection

    1. Domestic Well Location Inspection
    2. Site and Soils Evalulation
17. The Request for Discharge Authorization form (yellow sheet) must be received via fax or email before Final Construction Inspections are conducted. Upload complete Request for Discharge Authorization forms here.
19. Comments/Special Instructions
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field