2. Urbana & Champaign Sanitary District
   (217) 367-3409 Fax (217) 367-2603
   Email: Permits@u-csd.com
   Repair Permits - Complete information requested in Section 1-6, 9 & 10. Submit by email, online, fax, or deliver to the UCSD office. UCSD will fax the permit authorization and inspection form to the appropriate Municipality's inspection department. The Installer can pick up the permit at that office. UCSD will process applications received before 12:00 noon by 4:00 pm that day, after 12:00 noon by 12:00 noon the following day.
   
   New Connection Permits - Complete information requested in all Sections 1-10. Email, fax, or deliver to UCSD office. Pay the required connection fee and pick up permit at UCSD's office between 8-10 AM and 2:30-4:30 PM. Allow 24 hours for permit processing. Fee questions? Email: Permits@u-csd.com. The fee increases May 1st of this year.
6. For Office Use Only
   Parcel # _______-_______-_______-_______-_______
10. 1. Permit Type*

    Check one

    1. New Connection
    2. Repair
12. 2. Property Owner*
13. Phone*
14. Owner's Email Address
16. 3. Owner Address*
18. 4. Installer*
19. Phone*
20. Fax
22. 5. Jobsite Address*
24. 6. Subdivision & Phase
25. Lot No.
27. 7. Property Use*

    1. Residential
    2. Commercial
    3. Industrial
    4. Institutional
    5. SIC Code
29. 8. Describe Use*
31. 9. 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
33. For each item checked, indicate where water is discharged
35. I hereby certify that information supplied is true, completed and accurate to the best of my knowledge.
37. 10. Owner/Installer Name*
38. Date*
42. For Office Use Only
    Municipality: ___________ Permit No: _____________ Date Issued: ___________
    
    Sewer Connection: Interceptor ______ Lateral ______ Use Code _______
    
    Connection Units: P.E. ______ Amount Paid _______________ Check # _____
    
    Manhole Policy: Yes _____ No _____ Interceptor Tap Policy: Yes _____ No _____
    
    Repair Permit Authorization: _____________________ Date: _________________
Leave This Blank:


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

    This field is not part of the form submission.

46. Submit

* indicates a required field