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„o, City of South Rend Pubic Works Phone. 574.235,9251 <br />-d son0southbendin-gov <br />Email ham <br />4227 W. Jeffn, County City &Adw�g 11316 <br />e S*ulh behd, IN 46601 -TaN <br />TRAFFIC CONTROL AND� OCCUPANCYREQUEST <br />"SUBMIT 5 WOW DAYS MINNUM PRIOR TO IFROJECT START DATE <br />PLAN YOUR START DATE ACCORDINGLY TO AVOID DELAYS <br />Complefe I - 5 Mcomplefe Submiffals �Cannot Be Processed <br />Parking Lane Travel Lane Full Road Ckxsure Alley Sidewalk Closure <br />2 Excavation/Boring? > Requires Excavaflon Form Conshucffon? > Requires Curb Cut <br />alpplicafion or sidewalk permit <br />Submission Date: November 27, 2018 Applicant/Comparly- Woodruff & Sons, Inc. <br />Name, Bruce R, Woodruff Eploill Address: brucew@woodruffandsons.com <br />Phone #, 219-872-8605 C."Ca <br />co$ Conlraclor PerfcIming Work, Woodruff & Sons, Inc. <br />Ed Byers 219-898-6831 <br />On -Site Contact Phone #1, <br />Project STREET ADDRFM [ego 1 10 W_ Smilh RDJ- <br />Project Location (Block limits/Streels From and To): <br />Requested Start & End 1)qtes: Requested Start & End Times; <br />Reason for Closure: <br />4 <br />Affected Customers. <br />- <br />ujt 1,::, f(;)- J w0h <br />ATTACH 1HE F(MOWING TIEMS., 1. Traffic Control Non 2. Detour Plan 3. Barricades, Signs, or flasher. Placement <br />(Ref"Jo141UTC0 for Traffic ConktA Elevke Requkements) See reverse for Checkhil <br />FaSure to use traffic COntIM f0F *Gffit FestricSom or closuses will iresuff in stop work orders anal jor delay fn pern-iffing. <br />5 THIS OCCUPANCY PERMIT REQUEST IS NON-TRANSFERAKE AND A SIGNATURE SUILIECTS THE NAMED CONIRACTOWERMITTtE <br />TO All APPLICABLE RULE&. DUFIES AND ORUGATIONS WA?03ED BY THE CITY Of SOUTH BEND MUNtCAPALCODE AND TO ALL <br />REGULATIONS IMPOSED BY THE SGUTH BEND BOARD Of PUBLIC WOR113. <br />Appricanf Signature Dole <br />Aploroved Approved as Noted Revise Not Approve,10 <br />ISTOM =1 <br />City of South BendlEngineering Division Authorized Signature Dole- <br />vonhon U ls/2110141 <br />Version 7120/2018 <br />Contractor's Bid for Public Works- 13 <br />