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Temporary Encroachment Permit for Sidewalk Sale Application

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  2. NOTE: This Application must be submitted at least 14 days prior to the date of the Sidewalk Sale.
  13. If applicant is a corporation or partnership, provide names and resident addresses of the officers.
  20. APPLICANT MUST BE OWNER OF GOODS TO BE SOLD
  29. ATTACHMENTS REQUIRED
    • Certificate of Insurance indicating proof of Public Liability and Property Damage in an amount acceptable to the City naming the City of Carbondale, Illinois, as an additional insured. • A signed copy of the Release Statement which will hold harmless the City of Carbondale from any liability which may result from the encroachment or issuance of any encroachment permits. • Application Fee of $10 in the form of a check made payable to the City of Carbondale.
  34. Electronic Signature *
    I have read and understand the requirements for a Sidewalk Sale contained in Section 17-1-E-2 of the Carbondale Revised Code. I understand a minimum 3 foot wide passageway shall be left accessible for pedestrians and no merchandise shall be displayed within six feet of the cub line of the street. This permit shall be valid from date of inception until December 31 of the same year unless sooner terminated by the City of Carbondale.
  41. RELEASE*
    • With the intent of binding myself, my heirs and assigns, execute this RELEASE in favor of the City of Carbondale, Illinois, its officers and employees, 200 South Illinois Avenue, Carbondale, Jackson County, Illinois. • I hereby release and discharge the City of Carbondale, Illinois, its officers and employees, from any and all claims which may arise from the encroachment permit granted by the City of Carbondale, Illinois, for the purposes of holding a sidewalk sale during the dates provided, upon public right-of-way of above listed business address. • In consideration of receiving this encroachment permit, I, my heirs and assigns, hereby agree to indemnify and hold harmless the City of Carbondale, from any and all actions, proceedings, claim of liability and damages, including but not limited to compensation for damages, attorneys’ fees and court costs, asserted or awarded against the City of Carbondale, Illinois, resulting from the encroachment or from the issuance of the encroachment permit. • I further state that no promise or inducement has been offered except as herein set forth; that this RELEASE is executed without reliance upon any statement or representation by the parties released; that I am of legal age and legal competency to sign this RELEASE; that I understand the terms herein and I have signed the RELEASE on my own free act.
  45. Electronic Signature Agreement*
    By checking the "I certify" box below, you certify (or declare) under penalty of perjury under the laws of the State of Illinois that the foregoing is true and correct.
  49. 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.
  56. Pursuant to Authority contained in Section 17-1-5-E-2 of the City of Carbondale Revised Code, this Temporary Encroachment Permit is issued to:
  60. For the purpose of a “Sidewalk Sale.” This License is issued with the understanding that the above is/are familiar with and agree to abide by the provisions of Section 17-1-5-E-2 of the Revised Code of the City of Carbondale.
  62. Leave This Blank:

  65. This field is not part of the form submission.