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Franchise Application Form

2. Yakima County Franchise Request From
   This is where I would add text explaining who, what, where, why and how the applicant needs a franchise application

   This is where I would add text explaining who, what, where, why and how the applicant needs a franchise application

4. Date Submitted
   Date Submitted

   Date Submitted

6. Applicant Name*

   Individual or Business Name

7. Applicant Type*
   -- Select One --OwnerContractorUtility

   Indicate identity of applicant

9. Address*

11. City*

12. State*

13. Zip Code*

15. Email Address (Required)*

16. Phone Number*

18. Parcel Affected #1*

    Ex: Parcel # 123456-78901

19. Tribal Parcel
    -- Select One --NoYes

    Tribal Allotment / Parcel

21. Parcel Affected #2*

22. Parcel Type
    -- Select One --Fee ParcelTribal ParcelTribal AllotmentGovernment Parcel

24. Site Map Submittal

    Attach Site Map (pdf. jpeg. etc,) showing location of proposed utility.

Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field