Economic & Community Development Building Safety Division

WATER/SEWER SERVICE REPAIR/REPLACEMENT & MISC PUBLIC WORKS PERMIT APPLICATION

APPLICATION SUBMISSION AND PROCESSING

Please allow up to 5 business days for processing and approval of your application.
Once the application has been approved, our front office staff will be in contact with you for payment.
You can pay by credit card over the phone, or submit a check via US mail.
Once payment has been received, your permit will be issued and emailed (if you have provided us with a valid email).
Work can begin once the application has been approved and paid in full.
Working prior to permit issuance could result in further fees, fines, and/or legal action.
If you have not heard from us after 5 business days, please feel free to contact our front office staff at 309-434-2226.

PERMITS MUST BE OBTAINED BEFORE WORK BEGINS.
ACCEPTANCE OF PAYMENT DOES NO CONSTITUTE A PERMIT.
SUBMISSION OF THIS FORM DOES NOT GUARANTEE OR GRANT APPROVAL TO START WORK.
APPLICATION VOID IF WORK IS NOT STARTED WITHIN 6-MONTHS AFTER PERMIT ISSUANCE.
PLEASE ALLOW UP TO 5 BUSINESS DAYS FOR APPROVAL. .

Applicant

Owner

Excavation Contractor (Company applying for permit)

Plumbing Contractor (Company applying for permit)

Anticipated start date

Anticipated end date

Type of permit you are applying for - Check all that apply

Water Service install/replacement

Sewer Service install/replacement

Excavation/utility permit

Erosion permit

Water meter permit

Plumbing permit will also be needed for scope of work

Water Meter size needed

Name and address of the personal responsible for the water bill?

Site address (Include unit # if applicable)

Address or Location

Is the property commercial or residential?

Owner Email address

Owner Phone Number

Contractor/Company name (Must be a registered contractor with The City of Bloomington)

Contractor Email

Contractor Phone Number

Is this part of a larger project?

If yes, please provide name of project or the project assigned application number

Description of work

Will you need traffic control permit?

Will you need street closure permit?

If you answered "YES" to needing a street closure permit or a traffic control permit, please go to: https://www.bloomingtonil.gov/departments/public-works/contractor-consultant/permits-fees to submit that application to our Public Works Department.

Will you need to cut the street or sidewalk? Deposit amounts due if yes - $200 for sewer service - $100 for water service.

Will you need an excavation/utility permit? $40.00 **Utility permits are required for water meter installations**.

Plumbing items needed (check all that apply)

Backwater valve (sewer) $15.00 each

Grease or Gas/Oil Separators $30.00 each

Service - Water $30.00 each

Service - Sanitary Sewer Connection $30.00 each each

Service - Storm Sewer Connection $30.00 each

No plumbing items needed

How many Backwater Value (sewer)?

How many Grease or oil separators?

How many water services?

How many sanitary sewer connections?

How many storm sewer connections?

Is your total cost of work over $25,000?

Total plumbing cost of work?

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First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.