Connection Permit Application

2. Urbana & Champaign Sanitary District

   (217) 367-3409 Fax (217) 367-2603

   Email: Permits@u-csd.com

   New Connection Permits - Complete information requested in all Sections 1-8. Email, fax, or deliver to UCSD office. Pay the required connection fee and pick up permit at UCSD's office between 8-4:30 PM. Allow up 10 days for permit processing.  Questions? Email: Permits@u-csd.com. The fee may increase on May 1st of each year.  See https://www.u-csd.com/153/Connection-Permits for current connection permit fee amounts.

6. For Office Use Only
   Parcel # _______-_______-_______-_______-_______
10. 1. Property Owner*
11. Phone*
13. Owner Address*
15. 2. Installer*
16. Phone*
17. Fax
19. Installer Email:
21. 3. Jobsite Address*
23. 4. Subdivision
24. Lot No.
26. 5. Property Use*

    1. Residential
    2. Commercial
    3. Industrial
    4. Institutional
    5. SIC Code
28. 6. Describe Use*
30. 7. Storm water drainage provided for building

    Check all that apply

    1. Downspouts
    2. Footing Tiles
    3. Sump Pump
    4. Window Wells
    5. Stairwells
    6. Area Drain
32. For each item checked, indicate where water is discharged
34. I hereby certify that information supplied is true, completed and accurate to the best of my knowledge.
36. 8. Owner/Installer Name*
37. Date*
41. For Office Use Only

    Connection Units:  P.E.  __________   Amount Paid _______________   Check # ___________

    Manhole Policy: Yes _____ No _____ PIN # _____________________ 

    Permit Authorization: __________________________ Date: _________________

    Municipality: _____________________  Permit No:  ____________  Date Issued: ______________

    Sewer Connection:  Interceptor __________  Lateral __________ Use Code __________

Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field