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2. 

3. Village of Schiller Park

   Cook County, Illinois 

   Local Liquor Control Commission 

   Exterior Sales Permit Application

7. All Applicants please answer the following questions
9. 1. Name of Corporation, LLC, Partnership, Sole Proprietor, etc
11. 2. Address of premises to be covered by Exterior Sales Permit:
13. 3. Applicant is applying for or currently holds the following license classification:
    -- Select One --Class AClass ACClass C Class L Class PEClass R Class W
15. 4. Description of proposed or existing outdoor area, including the following:
17. Dimensions of area:
19. Number and size of tables
21. What number capacity of people:
23. Other information/ description:
25. 5. Does the applicant own or lease the property that the outdoor area is located on?
    -- Select One --Own Lease
27. 6. If leased, provide name of property owner, and COPY OF LEASE
29. Is the outdoor area located more than one hundred (100) feet from any church, school, hospital, home for aged or indigent persons, or for veterans, their spouses or children?
    -- Select One --YesNo
31. 8. Is the outdoor area located more than twenty (20) feet from a residential zone?
    -- Select One --YesNo
33. 9. Does the applicant have any outstanding debt, fine, penalty or judgment due and owing to the Village?
    -- Select One --YesNo
35. 10. Does the applicant’s dram shop insurance cover the outdoor area?
    -- Select One --YesNo
37. 11. Does the applicant have general liability insurance coverage for the outdoor area?
    -- Select One --YesNo
41. YOU MUST ATTACH A COPY OF YOUR CERTIFICATE OF INSURANCE COVERING THE OUTDOOR AREA.
43. 12. Is payment for the annual fee in the amount of One Hundred Dollars ($100.00) submitted with this application?
    -- Select One --YesNo
45. 13. Is all of the information contained in this application true and correct?
    -- Select One --YesNo
47. 14. Do you agree to abide by the laws and Ordinances of the Village of Schiller Park, including but not limited to Title IX, Chapter 94, Noise, and Title XI, Chapter 110, Alcoholic Beverages?
    -- Select One --YesNo
51. Submit drawing or design of outdoor area *
52. Submit Insurance for exterior *
56. 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.
58. Electronic Signature
60. Printed Name of Signatory
62. Title of Signatory
64. Email Address
66. Phone Number
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field