Village of Wauconda Building, Zoning & Economic Development Department
109 W. Bangs Street, Wauconda, IL 60084 w Ph: 847-526-9609 w Fax: 847-526-8967 w e-mail: BZ@wauconda-il.gov
White: Building & Zoning Canary: Collector Pink: Applicant
APPLICATION FOR RESIDENTIAL DWELLING INSPECTION
REAL ESTATE SALE RENTAL TRANSFER CASE #: ___________________________
Application Date: ____________________ Property Closing/Rental Transfer Date: ___________________
Property Address: __________________________________________________ Unit #: _________________
Owner of Property: ______________________________________________ Phone: ___________________
Owner Mailing Address: (if different from above) _________________________________________________
# of Bedrooms:_______ # of Bathrooms: _______ Basement: yes no
► A $95.00 fee is required for each separate dwelling unit to be inspected. Fee Includes one re-
inspection, if needed. If dwelling fails the 2
nd
inspection, a $35 fee is required for a 3
rd
inspection.
► Power and water must be turned on prior to inspection. Dwelling cannot be winterized.
► Owner must contact the Utility Billing Clerk at (847)526-9604 for a final water meter reading.
I hereby authorize and consent to the Village of Wauconda Building and Zoning Department’s on-site inspection of the building/premises located at
the address indicated at the top of the form on a scheduled date and time. I grant this authorization and consent freely and voluntarily, without any
threats or promises having been made to me.
Under penalties as provided by law pursuant to 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this
application are true and correct, except as to matter therein stated to be on information and belief, and except as to such matters, the undersigned
certifies as aforesaid that he verity believes the same to be true.
Owner/Agent will pick up Certificate of Compliance Fax Certificate to________________________________________
E-mail Certificate to (please print clearly): ______________________________________________________________________
Scheduling Contact: _________________________________________ Phone: _______________________
Printed Name
Owner/Agent: ______________________________________________ Date: ________________________
Signature Required
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For office use only
1
st
Inspection Date: ______/______/______ Time: _____________ am/pm Pass Fail _________________________
Inspector signature
2
nd
Inspection Date: ______/______/______ Time: _____________ am/pm Pass Fail _________________________
Inspector signature
3
rd
Inspection Date: ______/______/______ Time: _____________ am/pm Pass Fail _________________________
(Re-inspection fee required) Inspector signature
$95 Fee: Cash E-Pay #: _____________ Check #: __________ Date paid: ____________
$35 for 3
rd
Inspection Fee, if required: Cash Check #: __________ Date paid: ____________
Collected by: __________________________________________, Wauconda Building & Zoning Department
