APPLICATION FOR WATER OR WASTE WATER SERVICES

The following application must be completed and submitted to Yakima County Public Services when establishing a new service or when changing the name at an existing service.  If the service is for a rental unit and the bill is to go to the renter, then please complete information for both the Legal Owner and Occupant.  All permit charges must be paid at the time the application is made.  This application may be printed, signed and delivered to Yakima County Public Services, 128 North 2nd Street, Room 200, Yakima, WA 98901 along with the necessary permit charges:
 

System:      
Parcel #:    * (If parcel number is unknown Go Here )
Legal Owner: * Phone:*
Address:    *
City:     * State: * Zip:*
Structure:*
    Single Family   Duplex     Apartment 
    Commercial     Industrial
IF OCCUPANT OTHER THAN OWNER, LETTER FROM OWNER AUTHORIZING INSTALLATION/BILLING TO BE SENT TO OCCUPANT MUST BE ATTACHED.
Occupant: Phone #:
Address:
City: State: Zip: 
* Required Field
NOTICE: COST OF INSTALLATION IS NOT COVERED BY PERMIT FEE. INSTALLATION COST WILL BE BILLED WHEN CHARGES HAVE BEEN FINALIZED.


The following information is required by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in anyway. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.

Ethnicity:   
    Hispanic or Latino     NOT Hispanic or Latino
Race:
    American Indian/ Alaskan Native Asian
    Black or African American Native Hawaiian or Pacific Islander
    White  
Sex:      
    Male          Female
This institution is an equal opportunity provider.
Esta institucion es de oportunidad igualada
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