Yard Drainage Assistance Program Application Form - Village Of Skokie Community Development Department
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Residential Yard Drainage Assistance Program
Case Number:__________
VILLAGE OF SKOKIE
Inspector:______ Zoning: R-1___ R-2 ___
Owner Contacted: Yes___ No___ Date___
Community Development Department
Building Division
Pump Approved: Yes ___ No ___
5127 Oakton Street • Skokie, IL 60077
Pump Deposit: $100 Yes___ No___
Phone (847)933-8223 • Fax (847) 933-8230
Pump Delivery: Date _____
Pump Pick-up: Date _____
Drainage System Approved: Yes ___ No __
ALL ITEMS MUST BE COMPLETE TO PROCESS APPLICATION
Name(s)
Dated
Address
Phone
Email
CHOOSE ONE – Applying For: Pump Loan Program ___ OR Drainage System Design Assistance Program ___
Is this the first time your yard has flooded? Yes __ No __
How deep is the water at the low point of your yard? Feet__ Inches __
What part of your yard does the flooding affect? Front ___ Side _____ Rear ___
How long does your yard flooding generally last? Weeks ___ Days___ Hours ___
Have you made any changes to your yard or home lately that have increased the flooding problem? Yes ___ No ___
If yes, what have those changes been? _____________________________________________________________
Does the yard flooding affect any adjacent properties? Yes ___ No ___
How many properties on your block do you estimate are affected by the flooding problem? ______
PUMP LENDING PROGRAM REQUIREMENTS AND AGREEMENTS
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.
2. I agree to allow Village employees on my property for inspection and other purposes related to the use of the
pump.
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.
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.
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.
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.
___________________________
_____/_____/_____
Participant’s Signature
Date
#64005 v1 - Yard Drainage Assistance Program Form
Revised 4/17/2001:STM
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