R-278 - 06/24/1980 - IDOT - Resolutions Supporting Documents dempost frine-ses-nne, 0.27
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APPUCATION FOR PERMIT
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TO THE STATE OF ILLINOIS
RY AND THROUGH THE -AR OF TRANSPORTATION
DIVISION OF WATER RESOURCES
Pill of Ogle Bx k
A CAN'T ._.
I200 Oak "rook Road Street
xllinoss coda 60521
my ila�it Bse�c �E �_...._-.� it
Nom. of Auegus or 'Trilantary to Salt Creek
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• tics of ' . ! 3IR R*ng&. in 1
oaf the �r „_, F.Irt
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(I) T astir a penult to replace existing CMP culverts
with concrete boxes under Adana Road and Spring Road on a tributary
to Salt Creek
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which shell be constructed in accordance with plain and specifications which said applicant has caused to be pre-
pond and whist are attached hereto sad aurae a pert hereof. The plans shall be on SW x 1 t" sheets except
for plans for dams and shall furnish adernate and complete details and all pertinent Information regarding the
proposed work, including a dadinits location of the work with respect to established land lbws.
(2) The applicant reseeeents that „_,he___, it L- hi_ are__ the owner(s),L lessee(s)__ of the following
demand real estate (Give Legal Description) on which the proposed project is to be located, to-wit:
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(3) That said real estate nomulkod by Aden* and Spring Roads and Bight-of-Way
for transportation
purposes; that the title of record to said real estate is it the score of the Village of Oak Brook
and that no other person or persona,finis or Irma,corptwMion or other part►hes,or cashes to have any right,title
or hderest it possession,remaindrw,seversion or otherwise in and to said reel estate,except
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. go Row Ai 1
(4) The applicant bather repromete that said reject or the uselltrest we#, if and when completed. not
pollute or defile said deem,lake or pond,or with the natural Bass of the waters of said sue.
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(b) The appties r'k further reirtINIkenti fiat said project wia, if and when completed,not flood or damage ad- '
.joining proprety either . its 1, •
(6) The applicant agrees to reateao an pates,esflarAtatea, false work, excavation and material, incident to
the cote ttaection of the prom which a permit is herein requested horn the rimer, stream or lake In which the
work is dace, at his own menet. Shookl the spplintet ba to meow endr attneturee or natdmiel, the State re-
serNs the right to have such me&at the of the If Aaiun oriculluut for public nevi-
gallon by the or Tederel Goverment or public interests of say character neesesitate any changes in the po-
sitions of any parts of the parject for width a is hateht tequested, the aggikent or his summon agree to
stake such changes ill astrh 111111111fter as she§be fbed and Opermined by the Mato of Illinois, acting by end
through the Department of Tromertation or Muted sebroW. within tbrAY dot's from receipt
of wriUnt notice from the D por of Troespeetetion or bd agency that such charges
must be Dia& II
(7) It the project for which a ifs located far is in or along a the t agrees j
that he nor his as the WOW or lease of the oboe.described vast oa(a* nor his s0000toors in i
tithe shall make any dabs whatsoever to as ► ri$4,title or kdiereot in and to any acaletkes cased by the car- 1I.
straction of said project, and that they hereby remises convey,release and qdi unto the people of the State I
of ' for the um and of le all ' to any which rimy zoom to said real estate be-
cause of said
(0) That neither the a epilieent nor his in title shall All at any place along said shore line with
mks,, clay, debris, refuse or other as herein welded. II
(9) 'Tk•s applicant further agrees and understands that the permit requested herein. if issued, does not con-
vey,lease .o-provide any rig!i or of occupation or ease of the public cr private property on a`rich the pro-
poeed project or any part thereof may be located, or otherwise grant to the applicant any right or interest in or
to said property, whether said property is owned or poisoned by the State of Illinois or by any private or public
party or parties. II
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(10) The applicant further agrees,if the requested permit is issued, to comply with all Federal, State and 1
local laws, ordinances and repulatica which may pertain to the project.
(11) Give names and of all adjacent property owners The location of the property of the
adjacent owners must also be klentified on the elates.
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Fullersbure Woods Forest Preserve • i, ' :• ! •• • •
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Dr. Gilligan, 3400 Adores RoadL Oak Brook Illinois 60 21
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41110 ft.-27g
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(12) `Dee Department of Tramportation in issuing the permit basin applied for may rely upon
the statements
Wrronnie the Signature__ and seal__ of the applicant__ the
day of
Ju,ie
A.D. 19
' ' AST ,+',+�'"''/ ' 'i ' [s +r.]
Vence F F. Cerne , twit.] I'
`� ���, R.Tr:�,.�-a s._/r�'-�t' -'�:��` President "; r r ,
�' Village ' L,/[y' 1 ,.
Village Clerk
MEAL) �.....---- S •
STATE of ILLINOIS,
L / tf',p1 NTy or e , .
I, . 4. . ,— 0.1 + ar .f.. r_•x a Notary Public in and for and residing in said County in the
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State aforesaid,do hereby certify that .. ..1.. _ ... '-.- ..f._ Al 4 4:..*∎1,L.... 5.-.e.
personally known to me to be the same person_whose name subscribed to the foregoing instru-
ment, appeared before me this day in person and acknowledged that.— he:signed, sealed and delivered the
said instrument, in the respective capacities therein set forth, as free and voluntary act for the
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use and purposes herein set forth and declared that the statements therein contained are true.;' {
Given under my hand and Notarial Seal this-
pC(P day of I e^^-Q - \ 'A.d 19
.'mil 411 ff.1•ie . '
Notary Public.
POMP P1* 1C STALE CF RAMS
gg COMMISSICIa MIRES OCT.M l
MAD itikti ILLWNOlS NOUN lie
NOTE
If the applicant is a corporation have the President or other authorized officer sign the Corporate name by him as Presi-
dent; also have the Secretary attest his signature as Secretary and affix the seal of the corporation.This acknowledgment
should include both the names and capacities in which each officer executes the application.
If the applicant is a partnership have each partner sign.
the
If the applicant is a county, city, or other municipal orporation have the application signed by he��Wo a anti fled
County Board,Mayor, or other officer and have the proper clerk attest the same and affix the corpo
copy of the resolution or ordinance authorizing the application must be attached.
If the applicant is a Trust,have the Trust Officer sign the name of the Trustee by Mm as Trust Officer.A disclosure affi-
davit must be filed with the application identifying each beneficiary of such trust by name and address and defining his
interest therein. plans
otherwise newmary,shall be securely attached to pthe top of page three by adequate clips or ethers means.
�application,or
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The Illinois Statutes that it shall �e „ make fill or deposit of rock, earth, sand ear II
other material, or any ray matter of any kind or description or or commence the building of any wharf,
pier, dolphin, boom,weir, breakwater,bulkhead,jetty, causeway, harbor or mooring facilities for watercraft, or
build or oxiimenco the building of any other structure, or do any work of any kind whatsoever in any of the pub- '
lic bodies of water within the State of Illinois, without first submitting the plans, profiles, and specifications
thezef m,and aa&other data and information as may be required to the Department of Transportation of the State
and receiving a permit therefor signed by the Secretary of said Department and authenticated by the seal thereof.The
building of any causeway, harbor or facilities for watercraft in Lake Michigan shall be confined to those
areas recommetuled by the Department and authorized by the General and appmned by the'Governor
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',alai be in aid of and not an interference with the public interest or navigation:-- ` ,
(I 1, r"�'! �f3tat(, Chapter apter 19, Pars. 65 and 65a). - :
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' 'Fhe'Illinois:Statutes further provide that all construction undertaken on a defined flood plain subsequent'to`the 4.
�t• effective 'date ofe the amendatory Act (September 17, 1971) without benefit of a permit from the Depsrtnienf of
f Transportation; shall be unlawful. (ill. Rev. Stat. Chapter 19, Par. 65f) ∎1, i'' ( '
*N.. sF,Mf,MK1p pryKwyq ,6M�K a wf.,, ■t.• ••. ' 1 f•
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r Any correspondence regarding an application for
I permit for work in the Northern Area should be
�i �*� sent to:
�,,.)i v_ "'::° 1''s _ Division of Water Resources
_.1 H Woodfield Plaza Building
r..;�r 1000 Plaza Drive
,• • ....3 ..,." Schaumburg, Illinois 60196
m •
reaw
K,., ' Any correspondence regarding an application for ,
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permit for work in or along Lake Michigan should
• IiRTOM,- sKAIM be bent Ws
K4.MC, ,Y:T weer
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Division of Water Resources
:`�""� Marina Towers Building
.) "1--' a,.„ 1 300 North State Street
_: """`" Chicago, Illinois 60610
:say Poll
ca z•.-.1 ~�� ` Any correspondence regarding an application for
A ':"�'" l GFIELD ��"' work in the Springfield Area should be sent to:
..� RetlTT�a ���!i9i�
4 .. t,;AREA -. h-co -r i Division of Water Resources
.--- ,, ..,• °*�'`-N: .. ,,L.. 2300 South Dirksen Parkway,Room 010
-- _""` Springfield, Illinois 627$4
f i- i 1 Additional copies of the Application for Permit
-r.»; _ 1 form may be obtained from any of the.above of
i. .u. `.,.. flees.
Wm-- i°" 1 TWO copies of the APPLICATION FOR PER-
�...---{_- '"—" -�' MIT form properly esecuted and THREE corn-
«. ,Tff~i plate sets of PLANS AND SPECIFICATIONS
I LLI1\tOI!3 1. ! -a-" must be submitted for each project.
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