Cook County Commissioner Elizabeth Gorman
We are no longer accepting reports through the use of this form. PLEASE DO NOT complete this form. Effective 05/05/2013, Any information submitted via this form cannot be processed. Instead, please complete the form found at this link:
PROPERTY LOCATION AND TYPE
What Township do you live in?
Elk Grove Township
New Trier Township
Norwood Park Township
Oak Park Township
River Forest Township
City of Chicago
I'm Not Sure
Enter the number portion of your address:
Enter just the number from your home address. Please do not put in an apartment number here.
Enter the Street Name:
Enter just the name of the street here. Please do not enter an apartment number.
Name of your City/Village:
Do you live in an UNINCORPORATED area?
Type of structure:
Single family home
Please select the appropriate building use type.
Please let us know whether you rent or own
FLOOD / DAMAGE INFORMATION
Location of flood water:
2nd floor or higher
Water kept out because of sandbagging, sewer valve or other protective measure
Other (Please specify)
Please let us know what area of your home flooded.
Depth of water in basement or crawl space?
Please indicate in inches. Example: 1 foot, 6 inches would be reported at 18.
Basement living area?
Does the basement contain essential living features, such as a furnace/boiler, hot water heater, or spaces critical to the functioning of the house? Family/dens rooms are not considered essential living areas. A finished basement is not necessarily an essential living area. A basement apartment or garden apartment is considered an essential living area.
Comments regarding basement living area.
Is the home a split level/tri-level with living area in the lower level?
Check all that apply
Structural damage IS: collapsed basement walls, large cracks in the foundation, etc.
Structural damage IS NOT: damaged drywall, carpeting, floor boards, padding, panellling, etc.
Comments on structural damage:
Additional relevent information:
No one living in dwelling at time of flood
Dwelling is not primary residence
Water in crawl space only
Damage caused by sewer backup only
No one home during damage assessment. Cannot determine damage
No one home during damage assessment. Information gathered by observation or other source
Use brief descriptions, such as: basement wall collapsed, house off foundation, large foundation cracks.
Other: Please list any other relevent information here:
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