Fillable Site Work Permit VILLAGE OF LINCOLNSHIRE

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Site Work Permit VILLAGE OF LINCOLNSHIRE

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The Site Work Permit VILLAGE OF LINCOLNSHIRE form is 3 pages long and contains:

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  • 0 check-boxes
  • 107 other fields

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 3
STAMP HERE
SITE WORK PERMIT APPLICATION
OFFICE USE ONLY
Permit #:
PROJECT INFORMATION
Property Address (including lot / suite #):
Project / Business Name:
Applicant Name:
Company:
Email:
Address:
City:
State:
Zip Code:
Phone:
Cell:
Fax:
PROJECT TYPE (check all that apply)
Driveway
Storm/Sewer Pump
Grading
Sidewalk
Sanitary Sewer
Parking Lot
Erosion Control
Water
Paving
Water Meter Required
Utility
Concrete Curb
Other:
DESCRIPTION OF WORK (check all that apply)
Residential
Commercial
Right-of-Way
Proposed Work is located off
subject site
H.O.A Approval Attached (if required)
Brief Description:
Site Work Permit Application – Village of Lincolnshire, IL – Public Works Development
1 Olde Half Day Road, Lincolnshire, IL 60069
www.lincolnshireil.gov
P: 847-883-8600
F: 847-883-8608
Page 2 of 3
CONTACT INFORMATION
Owner Information (if different than applicant)
Name:
Company:
Email:
Address (including suite #):
City:
State:
Zip Code:
Phone:
Cell:
Fax:
Contractor Information
Type of Contractor:
Name:
Company:
Email:
Address (including suite #):
City:
State:
Zip Code:
Phone:
Cell:
Fax:
Contractor Information
Type of Contractor:
Name:
Company:
Email:
Address (including suite #):
City:
State:
Zip Code:
Phone:
Cell:
Fax:
SUBMITTAL STATEMENT
I, , certify that the information contained in this application,
attached plans, and specifications, and other attached documentation is true to the best of my
knowledge. I also recognize that as the permit applicant, all fees and requirements associated with the
review and future approval of the work described herein are my responsibility.
Signature:
Date:
click to sign
signature
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Site Work Permit Application – Village of Lincolnshire, IL – Public Works Development
1 Olde Half Day Road, Lincolnshire, IL 60069
www.lincolnshireil.gov
P: 847-883-8600
F: 847-883-8608
Page 3 of 3
IMPERVIOUS SURFACE CALCULATION SHEET
The Village of Lincolnshire regulates the amount of impervious surfaces covering single-family
residential lots. Impervious surface is defined as “any man-made area that alters the natural surface
course for or does not allow for the natural rate of absorption or retention of storm water. Such areas
may include, but are not limited by reason of exclusion from the following list of examples, roofs,
parking and driveway areas, graveled areas, sidewalks and bike paths, paved recreational areas,
swimming pools, porches, decks and patios” (Section 6-2-2 of the Lincolnshire Village Code). Please
complete the following calculations to determine the total impervious surface area for the property.
IMPERVIOUS SURFACE TYPE
IMPERVIOUS SURFACE AREA (sq. ft.)
Existing
Proposed
Building Footprint (including garage)
Driveway
Walks
Decks
Porches
Patios
Swimming Pools
Detached Storage Structure (shed)
Gazebo
Recreational Structure
Other (list)
TOTAL
(a)
sq. ft.
(b)
sq. ft.
IMPERVIOUS SURFACE RATIO
(a + b)
÷
=
%
Total Impervious Surface
Lot Area (sq. ft.)
Impervious Surface Ratio
DESIGN PROFESSIONAL INFORMATION
Name:
Company:
Email:
Address (including suite #):
City:
State:
Zip Code:
Phone:
Cell:
Fax:
License #:
I, , declare that I have reviewed and/or designed the documents
associated with this application, and therefore, take responsibility for the design work on behalf of a
registered design firm. In addition, I certify that the information contained on the attached plans and
specifications, and other attached documentation is true to the best of my knowledge, and accurately
depicts the subject site on the date these documents were prepared.
Signature:
Date:
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signature
click to edit
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Site Work Permit VILLAGE OF LINCOLNSHIRE

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Completed 13 July 2020

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