Fillable Grading Waiver VILLAGE OF LINCOLNSHIRE

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Grading Waiver VILLAGE OF LINCOLNSHIRE

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Country of origin: US
File type: PDF

U.S.A. forms for Village of Lincolnshire

BROWSE VILLAGE OF LINCOLNSHIRE (IL) FORMS

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1 Olde Half Day Road, Lincolnshire, IL 60069 www.lincolnshireil.gov P: 847-883-8600 F: 847-883-8608
Page 1 of 1
STAMP HERE
GRADING WAIVER STATEMENT
OFFICE USE ONLY
Permit #:
PROPERTY INFORMATION
Legal Description (Fill in below or attached legible copy to this form):
P.I.N. Number:
Property Owner:
Lot/Suite #
Address:
Phone:
Cell:
City:
State:
Zip Code:
GRADING WAIVER
A plot plan must be submitted with this statement. The plan must show the following (if applicable):
• Dimensions of the work from all lot lines
• Height of the foundation
• The location of the driveway
• The provisions for roof drainage and proposed grading limits.
I, ________________________ hereby certify that I am the owner of the above described property
and certify to the best of my knowledge that the described project will conform to the conditions for plan
waiver stated in this Section, and will not create adverse drainage problems on adjacent properties.
I agree to assume all responsibility for any drainage problems that may be caused directly or indirectly
by any action involving the above described project, and further absolve the Village of Lincolnshire of
any responsibility for problems or actions that may result from the waving of the plan submittal as
required in Sections 5-8-3 hereof.
________________________________
Owner of Record
_________________________________
Print and Signature
Subscribed and Sworn to me before this
_________ day of _______________, 20__
_____________________________________
Notary Public
State of:
County of:
Notary Seal
FOR OFFICE USE ONLY
Waiver Approved/Not Approved:
Date:
By:
Village Engineer:
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Grading Waiver VILLAGE OF LINCOLNSHIRE

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Completed 13 July 2020

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