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STAMP HERE
RIVERSHIRE PARK CANOE RACK
PERMIT APPLICATION
OFFICE USE ONLY
Permit #:
APPLICANT INFORMATION
Name:
Date:
Address:
Time Submitted:
City:
State:
Telephone:
Email:
Resident:
To:
Amount Due: $ Receipt Code: 174
INFORMATION
1. Canoe rack permits will be issued only to Residents of the Village of Lincolnshire until June 1 of each year.
After June 1 a Non-Resident may be issued a permit if space is available.
Canoe rack permits are issued on a first-come, first serve basis.
2. A total of five seasonal permits will be issued annually.
Seasonal permits are issued for the time period May 1 to October 31 annually. Any canoe, kayak, or similar
vessel left on the rack after November 1 will be discarded. Only one seasonal permit will be issued per address
per year. Cost of a seasonal permit, see 1-15 Comprehensive Fee Schedule of Village Code (section attached).
3. Daily permits will be issued according to availability. Daily permits are issued on a three (3) day basis.
Any canoe, kayak, or similar vessel left on the rack after the permit has expired will be discarded. Cost of a
daily permit (three (3) day period), see 1-15 Comprehensive Fee Schedule of Village Code.
4. A permit tag will be issued to the approved applicant. This tag must be displayed on the canoe while it is on
the rack.
5. The Village is not responsible for any damage or loss associated with use of the canoe rack, including injury to
the permittee or to any person using the canoe rack. It is the responsibility of the canoe owner to provide a
lock or other adequate measure to ensure that the canoe is secure.
Permittee, whether an individual or group for its member, officers, guests, and invitees, if any, covenants and agrees that it/they
shall at all times protect, indemnify, save and keep harmless the Village of Lincolnshire from and against any and all claims, costs,
damage or expense arising out of or from any accident or other occurrence on or about the premises or arising from any activity
under this permit, causing injury or damage to any person or property. This is intended to be an absolute release and hold harmless
obligation binding permittee and benefitting the Village of Lincolnshire, its officers, agents and employees. This provision shall apply
irrespective of the condition of the amenity and to any acts or neglect of the Village of Lincolnshire, its officers, agents and
employees.
Name:
Date:
Signature:
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