Fillable FOR A SPECIAL EVENT OF PUBLIC INTEREST (Lake County)

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FOR A SPECIAL EVENT OF PUBLIC INTEREST (Lake County)

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BROWSE LAKE COUNTY (IL) FORMS

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Page 1 of 2
Rev. 02/11
FOR LCDOT USE ONLY
Application Number
600 W. Winchester Road
Libertyville, IL 60048
Telephone: (847) 377-7400
Fax: (847) 984-5944
Email: hdpermits@lakecountyil.gov
APPLICATION TO REQUEST TEMPORARY CLOSURE OF A COUNTY HIGHWAY
FOR A SPECIAL EVENT OF PUBLIC INTEREST
(This Form Must Be Submitted A Minimum Of 30 Days Prior To The Planned Event)
(Please print or type)
APPLICANT:
Name/Company:
Mailing Address:
Telephone:
E-mail Address:
In accordance with the Lake County Highway Temporary Closure and Utility and Facility Placement Ordinance, as amended, the
above Applicant hereby makes application to the County Engineer of Lake County for permission to temporarily close a section of
County Highway for a special event of public interest. This proposed closure is described as follows:
1.
Name of County Highway:
(If multiple County Highways are needed for the same event separate applications and fees are required for each County Highway)
2.
Limits of Closure:
(From street to street)
3.
Type of Closure:
Full Closure
Partial Closure
Other
Description:
4.
Type of Special Event (check all that apply):
Parade
Race (walking/running)
Race (bicycling)
Street Festival
Filming (movie, television, etc.)
Other
5.
Name of Event
Date(s) of Event:
Time Limit of Closure:
6.
Estimated Attendance:
Estimated Participants:
7.
Agent for Applicant (if applicable):
Name & Company
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
8.
Person in Charge (contact person for the day of the event and 24-hour emergency contact):
Name & Company:
Mailing Address:
Telephone Number:
Mobile Number:
E-mail Address:
9.
Police Department (police department handling the traffic control and closure of the County Highway):
Name & Dept:
Mailing Address:
Telephone Number:
Fax Number:
E-mail Address:
10.
Enclosed Application Fee
(all fees non-refundable):
NOTES:
Attach Course Route Map Or Location Map For The Special Event With This Application.
This Application Is Subject To The General Conditions As Printed On Page 2.
THIS APPLICATION IS ONLY VALID WHEN AN ORIGINAL SIGNATURE IS PROVIDED ON PAGE 2.
Page 2 of 2
Rev. 02/11
GENERAL CONDITIONS FOR APPLICATON TO REQUEST TEMPORARY CLOSURE OF A COUNTY HIGHWAY
1. In submitting this Application, the Applicant agrees to comply with the various policies, conditions and requirements of the
Lake County Division of Transportation, whether written or verbal, and to the Lake County Highway Temporary Closure and
Utility and Facility Placement Ordinance, as amended, to make such changes and revisions to the Proposed Special Event as
may be necessary to comply or more closely conform to those various policies, conditions and requirements of the Lake
County Division of Transportation, whether written or verbal, and to the Lake County Highway Temporary Closure and Utility
and Facility Placement Ordinance, as amended.
2. The Applicant shall supply, at his expense, such information or submittals as the Lake County Division of Transportation may
require to complete the review of the Proposed Temporary Highway Closure.
3. Lack of an immediate response to this application form or any information submitted for review and/or comment shall not be
construed as approval or acceptance of the application or submittal.
4. The Proposed Temporary Highway Closure may not be permitted if it will create a hazard to the Public or interfere with the
ability of the Lake County Division of Transportation to operate and maintain the County Highway right-of-way.
5. This Application does not relieve the Applicant from obtaining permission and authority from the Federal, State, County or
Local Government or any political subdivision or administrative agency which may administer any statutes, regulations,
ordinances or administrative orders that pertain to the Proposed Special Event.
6. The Applicant is cautioned that the County Highway rights-of-way have been obtained for Public Road Purposes and any
other use of the right-of-way is subject to approval or permission from the legal property owner. The Applicant shall be
responsible for contacting the property owner and obtaining any required approval or permission.
7. The Lake County Division of Transportation, its employees and its agents, and the County of Lake, its employees and its
agents shall not be held responsible for costs or delays to the Applicant due to the processing time required by the Lake
County Division of Transportation to review information or submittals by the Applicant or his authorized agents.
8. The submittal of this Application by the Applicant does not obligate the County Engineer to issue a permit.
9. Application and Permit fees are non-refundable once processed.
10. If the Proposed Temporary Highway Closure is permitted the Applicant and his successors and assigns shall be generally
responsible for the following:
a. Obtaining any other permission or authority needed for the Proposed Special Event.
b. Supplying acceptable proof of insurance.
c. Posting advance notification of the Proposed Temporary Highway Closure to the motoring public.
d. Providing the required traffic control including signage and police/Sheriff presence or assistance if required.
e. Allowing safe passage of emergency vehicles through the Proposed Temporary Highway Closure.
f. Cleaning and maintaining the County Highway right-of-way during and immediately after the Proposed Special
Event. This includes keeping the pavement surface free of mud, gravel, debris, trash, and other extraneous
materials.
g. Other items as specified in the Lake County Highway Temporary Closure and Utility and Facility Placement
Ordinance.
SIGNATURE BLOCK
(Signature of Applicant)
(Printed name of above signature)
(Title)
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FOR A SPECIAL EVENT OF PUBLIC INTEREST (Lake County)

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Completed 6 August 2020

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