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Expires 10-87-15
Maricopa County
Animal Care and Control
2500 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT APPLICATION
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C1 New [& Renewal Permit # K@¥-000012
Name: Susan Anderson Kennel Name: Clearwater Kennels
Mailing Address: 7601 North 1 85" Avenue Kennel Location: 7601 North 185" Avenue, Waddell
City: Waddell ZIP: 85355 County Supervisoriai District: District # 4
Phone: -4 ; Kennel Phone:4
(ds ABSNOOD Cer bs b6AXAA\
Please complete and sign this application and return it to the above address with payment in the amount of three
hundred twenty eight dollars ($328.00) within ten (10) days of receipt.
Pursuant to Arizona statute and county ordinance, a person must obtain a kennel permit issued by the Board
of Supervisors if the person operates a kennel in which there are five or more dogs which are not individually
licensed. A.R.S. §11-1009(A). A kennel is defined as “an enclosed, controlled area, inaccessible to other
animals, in which a person keeps, harbors or maintains five or more dogs under controlled conditions.” A.R.S.
§ 11-1001(8).
An_ appointment will be scheduled for inspection of the kennel premises by an Animal Contro/ Officer upon
receipt of this kennel permit application and fee. This kennel application properly executed and a copy of the
inspection report will then be forwarded to, and must be approved by, the Maricopa County Board of
Supervisors. The kennel permit form will be sent to you after approval and will be valid for one year from the
date of the Board’s approval.
NOTE: Failure to show for a scheduled inspection and/or failure of inspection will warrant a Subsequent
Inspection Return fee of $49 for each additional visit. Failure of inspection may result in denial of the kennel
permit and require individual licensing of each dog under the provisions of A.R.S. §11-1008.
PLEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE
OL iMWe assume complete responsibility for the kennel at the premises for which I/we are making
application for a permit and understand that “kennel” means an enclosed, controlled area, inaccessible to
other animals, in which a person keeps, harbors or maintains five or more dogs under controlled conditions
(ARS 11-1001).
I/We certify that /We have } fs) dogs and that the kennel meets the definition in statute.
_
I/We certify that I/We have not been convicted of a violation of AR.S. §§ 13-2910 (cruelty to animals)
or 13-2910.01 (dog fighting), or similar violations of any other state, county or municipal animal welfare law.
(Violations of license and leash laws DO NOT apply).
Pe
We certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
premises of the above named kennel have been properly vaccinated against rabies by a veterinarian licensed to
practice in the state of Arizona and that a current vaccination certificate signed by a licensed veterinarian is
,
maintained on the premises for each dog.
\
| We certify that [We are submitting a valid copy of the rabies vaccination certificate for each
dog with this application.
IAWVe understand that a dog remaining within the kennel is not required to be licensed individually under
A.R.S. § 11-1008. Ifve also understand that a dog leaving the controlled kennel conditions shall be licensed
under A.R.S. § 11-1008 except if the dog is only being transported to another kennel which has a permit issued
under this section.
ENV We understand that a person whig fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
penalty of twenty-five dollars in addition to the annual fee. |
& IAWe understand that a person who knowingly fails to obtain a kennel permit within thirty days after
itten notification from the county enforcement agent is guilty of a class 2 misdemeanor.. |
NCH
The undersigned understand that that the-kennel permit does not authorize the operation of any type
of business and is solely used for the of licensing multiple dogs.
purpase a
We certify that all of the information I/We have provided is true and accurate under penalty of law.
sensei’ Nal: Qhadhonnane NEN ON AO
Applicant owe \A
Applicant Signature Date:
For Official Use Only:
Copies of Valid Rabies Vaccination Certificates for each dog attached
Copy of Person’s Valid Identification Attached
Type of Identification submitted
BOS Approval Date Term of Permit,
2 of 2
Maricopa County
Animal Care & Control
2500 South 27" Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K16-000012
PREMISE INSPECTION
Number of Dogs | 3
Name: SUSAN ANDERSON Kennel Name: CLEAR WATER KENNELS
Mailing Address: 7601N185'" AV —_—_ Kennel Address: 7601 N 185"" AVE
City: WADDELL State: AZ Zip:85355 City: WADDELL Zip: 8535
County Supervisorial District: #4
Phone: 623-935-4002 Kennel Phone: 623-935-4002
1. Are all dogs over the age of three months properly vaccinated for rabies and in
of a valid rabies vaccination certificate?
=
2. Is the kennel an enclosed, controlled area, inaccessible to other animals, in which a
keeps, harbors or maintains five or more dogs under controlled conditions?
aoe
NOTE: Copies of each rabies vaccination certificate must be attached to the Kennel Permit
Premise Inspection form.
CORRECTIVE ACTION NEEDED FOR COMPLIANCE AND N/A DAYS GIVEN
BEFORE REINSPECTION. (Note: There will be $49 re-inspect fee payable to the
Inspector by check upon each return visit.)
Deputy Enforcement Agent & Badge #: Lt Timothy Rummel Date: 11/05/2015
October 2015
Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets. maricopa.gov
Receipt Number: R15-247866 Receipt Date: 10/30/2015
Person ID: P7024491
Phone: 623 9354002
CLEARWATER KENNELS
10/30/2015 12:39:21PI .29:
7601 N 185TH AVE
WADDELL, AZ 85355
Item: Animal [D: Reference No: Price: Each: Amount:
KEN PERMIT AT777777 K16-000012 $328.00 1 $328.00
Total Fees Due: $328.00
Payments: Cash: $0.00
Check: $328.00
Credit Card: $0.00
Total Payments Received: $328.00
Thank You!
Would you like to share your experience with our service to you? Change: $0.00
Please visit our website at http://pets.maricopa.gov and click on Balance Due: $0.00
Contact
5 1 14 3 1 2 481 1784 62 31 96.532051 Us to email your comments for our review.
Animal Information:
A7777777 KENNEL PERM - BORN 9/14/1999, SPAYED, UNKNOWNIMIX, TRICOLOR DOG
License Information:
Tag Number: License Expires: Animal# Vacc Date: Vacc Expires:
Please retain this receipt with your pet's records
shawerof EBUSOFF
-4189 East County 15th St.
Yuma, AZ 85365
(480) 522-6857
Affordable
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5 1 9 1 1 5 810 1044 50 24 96.983154 Use
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