Form Center

2. Applicant's Name*
3. Business Name*
5. Business Address*
6. Location of Proposed Sidewalk Cafe*
8. Business Phone*
9. Manager's Name*
11. If applicant is a corporation or partnership, provide names and resident addresses of the officers.
13. Name of Corporation
14. Address
16. Partnership
18. PERMIT REQUIREMENTS
    • Sidewalk restaurants are permitted between 6 a.m. and 11:59 p.m. • A minimum four foot wide passageway shall be maintained for pedestrians to navigate safely past any tables, chairs or umbrellas. • Umbrellas shall have a maximum diameter of eight feet and a minimum clearance of seven fee above the ground, a weighted base and be cloth fabric covered. No signage, lettering or other graphics/logos shall be allowed on the umbrella face. • Any furniture used for the sidewalk café shall be maintained in good repair, shall be aesthetically consistent with the location and area for which the temporary encroachment is issued and shall be approved by the City Manager. All furniture must be removed from the area encroachment when the business for which the temporary encroachment permit is issued ceases operation for the day. • The City Manager may, at his discretion, impose additional requirements upon the permit holder as is necessary and reasonable to protect the health, safety and welfare.
20. This permit shall be valid from the date of inception until December 31 of the same year unless sooner terminated by the City of Carbondale.
22. 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. • A scaled drawing or sketch depicting the dimensions of the proposed permit area and which shows the location and type of tables, chairs, trash receptacles and other equipment proposed to be used, location of ingress and egress, the city-owned equipment facilities in or adjacent to the area proposed which are visible to the eye. This includes, but is not limited to, parking meters, trees, manhole covers and utility poles or openings. • An operations plan specifying the proposed dates, days and hours of operation of the outdoor restaurant, the hours of operation for the associated restaurant and maximum seating capacity for the area.
24. Certificate of Insurance*
25. Release Statement*
26. Scaled Drawing or Sketch*
28. Electronic Signature *

    I have read and understand the requirements for a Sidewalk Restaurant contained in Section 17-1-5-F of the Carbondale Revised Code.

    1. I agree.
30. Electronic Signature*
31. Date
33. Email*
35. 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 restaurant 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.

    1. I agree.
37. Electronic Signature*
39. 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.

    1. I certify.
41. Electronic Signature*
43. 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.
45. Electronic Signature*
50. Pursuant to Authority contained in Section 17-1-5-F of the City of Carbondale Revised Code, this Temporary Encroachment Permit is issued to:
54. For the purpose of a “Sidewalk Restaurant.” 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-F of the Revised Code of the City of Carbondale.
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field