Permit Applica�on for Ac�vi�es, Events and Occasional Uses in Buildings and Grounds
Instructions
1. Review Policy and Procedures and Lake County Ordinances governing Lake County Public Buildings and Grounds.
2. Completed application should be submitted in a reasonable period of time in advance of the proposed activity to Facilities
and Construction Services Department, 18 North County St., Rm. #105 (lower level), Waukegan, IL 60085, via fax at
(847) 662-7370, or facilitiesoperations@lakecountyil.gov.
3. Submit requests for posting/distribution of materials to the Communications Division, 9th floor administrative tower,
communications@lakecountyil.gov, or 847-377-2500.
4. The County will respond within 10 business days of receipt of application.
Applicant Information
Full Name: _________________________________ Agency/Group*: _____________________________
*If the applicant is partnering with a County department/agency for the event/activity, please list sponsoring department/agency.
*Applicants must provide a letter or other documentation showing that the applicant has authority to represent that organization.
Address: ____________________________________________________________________________________________________
Emai
l: ______________________ _______________ Telephone #: ________________________________
Description of Proposed Event/Activity/Use (Include use of audio/visual or amplification equipment or county services proposed to be
utilized):
__________________________________________________________________________________________________________
____________________________________________________________________
______________________________________
Plan to clean and clear the sit of debris, signage, etc. ________________________________________________________________
___________________________________________________________________________________________________________
Proposed Date(s): ________________________________ Proposed Hour(s): _________________________________
Proposed Location(s): ____________________
_____________________________________________________________
Estimated attendees: _________________________________
Statement of Indemnification
As represented by the Applicant’s signature, the Applicant agrees to indemnify, defend and hold harmless the County of Lake, its
officers, boards, commissions, agents, elected, elected officials, and employees against and from any and all losses, claims, demands,
causes of action, actions, suits, proceedings, damages, costs and/or liabilities of every kind and nature, whatsoever (including, but not
limited to expenses for reasonable legal fees
, and disbursements and liabilities assumed by the County of Lake in connection
therewith), to persons or property, in any way arising out of or through the acts or omissions of the Applicant, its servants, agents or
employees, or to which the Applicant’s negligence shall in any way contribute.
Signature of Applicant Date
Submit
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signature
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