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2. Residential Yard Drainage Assistance Program
   Community Development Department – Building Division 5127 Oakton Street - Skokie, IL 60077 Phone: (847) 933-8223
3. 
5. ALL ITEMS MUST BE COMPLETE TO PROCESS APPLICATION
7. Name(s):*
8. Dated:*
10. Address:*
11. Phone:*
13. Email:*
17. CHOOSE ONE – Applying For:

    1. Pump Loan Program

    1. Drainage System Design Assistance Program
19. Is this the first time your yard has flooded?

    1. Yes

    1. No
21. How deep is the water at the low point of your yard?

    1. Feet

    1. Inches
23. What part of your yard does the flooding affect?

    1. Front

    1. Side

    1. Rear
25. How long does your flooding generally last?

    1. Weeks

    1. Days

    1. Hours
27. Have you made any changes to your yard or home lately that have increased the flooding problem?

    1. Yes

    1. No
29. If yes, what have those changes been?
31. Does the yard flooding affect any adjacent properties?

    1. Yes

    1. No
33. How many properties on your block do you estimate are affected by the flooding problem?
38. PUMP LENDING PROGRAM REQUIREMENTS AND AGREEMENTS
40. 1. I understand that the pump loan program is for only a one-year period and is intended to reduce emergency yard flooding. As an applicant I will be expected to work with the Village to develop a permanent solution to the drainage problem.
42. 2. I agree to allow Village employees on my property for inspection and other purposes related to the use of the pump.
44. 3. The Village will provide the pump free of charge upon my submittal of the required security deposit. As the homeowner I will be responsible for operating the pump in compliance with the manufacturer’s operating instructions and verbal instructions received from the Village. I will also be responsible for the moving of the pump as necessary to properly drain my yard. I also understand that the pump cannot be used for standing water less than 2 inches deep.
46. 4. I agree to call the Village at 933-8427 to have the pump picked up when the flooding problem has been corrected. The Village may retrieve pumps if held for more than 48 hours to be used elsewhere if flooding problems develop in other locations, unless an extension is received from the Public Works Department.
48. 5. I understand that the use of the pumps is strictly for exterior use, for the removal of floodwaters from the yard. That the pump is not to be used within the home, and is not to be used, nor is it intended for use in removing water from a basement.
50. 6. I understand and acknowledge that my participation in the Village of Skokie Yard Flooding Assistance Program in which pumps are loaned to me for the purpose of removing flood waters from my yard is strictly voluntary and one which I have requested of the Village. I acknowledge my participation in this program involves certain risks, and agree by my signature below to assume full responsibility for my participation in this program and the equipment loaned to me by the Village. I release the Village of Skokie, its staff, officers, representatives and agents from any and all claims, demands or causes of action of any type or nature, and any and all liability arising out of my participation in the Yard Flooding Assistance Program.
52. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
54. Participant's Signature*
55. Date:
    Date:
59. Drainage System Design Assistance Program Requirements And Agreements
    The Village will assist you and your neighbors in designing a drainage system to correct flooding problems in your yard or block. Although the Village will provide the system design, assist in project biding, and inspect the completed system at no cost, the property owners must pay for the entire cost of building the system. Upon receiving the signed application the Village will meet with you and your neighbors to develop alternative methods for the correction of the flooding problem. By your signature you also agree to allow a Village employees on your property for inspections, surveying and other duties related to the design of a drainage system.
61. Primary Petitioner Information
63. Name(s):
64. Dated Signature:
66. Address:
67. Phone:
69. Email:
71. Co-Petitioner Information
    Click here

    Please use page two of the above link to gather the names, addresses and signatures of any co-petitioners.
73. Upload the signed co-petitioner form here.
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75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit Submit and Print

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