Laserfiche WebLink
"" r,, r TRAFFIC CONTROL AND OCCUPANCY REQUEST <br />City of South Bend - Division of Engineering <br />_ 227 W Jefferson Boulevard, Ste 1316 <br />n.., South Bend, IN 46601 <br />APPLICANT INFORMATION <br />Name of Contractor/Company: 4i.0is C�..�rr�ycr-i a.•� <br />Name of Applicant: A<< G'f2��/ <br />Phone: ZM-99f—J731.41*" Email Address: GOi`f <br />On -Site Contact:. Voe Z- -yetj Phone: 3/,Z- 22/ 9330 <br />PROJECT INFORMATION <br />Requested Dates (mm/dd/yyyy): 9 1 1-r /20 A 3 to S /20 A 4 <br />Time of Work: 7,0,1 to ,P'.?o P•N <br />Location of Work: ❑ Entire Street ❑ Travel Lane ❑ Parking Lane <br />(O'Sidewalk ❑ Tree Lawn ❑ Alley <br />Type of Work: ❑ Excavation/Boring (Also requires Excavation Form) <br />21jew Drive Approach (Also requires Curb Cut Application)(TEM/d.V^'*'%) <br />5?"Sidewa I k <br />Address of Project: �'� � �"� S � � ��^ • _y yr"�,O/ <br />Project Boundaries: I6%_,se d­ Al. &'AAA/# r,04 — �✓ i`1yia ,r� <br />Description of Work: T-.•,r�an•� L'va� cvr{ ,,;�,,o�G�sv�scs _ S�i�ec��f <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />VIT'raffic control plan including detour map and traffic devices. <br />❑ Communication (letter, door hanger, signs, etc.) to affected property owners <br />Failure to use traffic control for traffic restrictions or closures will result in stop work <br />orders and/or delay in permitting. This Occupancy Permit Request is non -transferable. A <br />signature subjects the named contractor/permittee to all applicable rules, duties and <br />obligations imposed by the South Bend Municipal Code and to all regulations imposed by <br />the City's Board of Public Works. l <br />Signature of Applicant: Date: <br />Applications should be dropped off to the City's Engineering Office or emailed to <br />rowper-mitsoffice@southbendin.gov. For questions, contact Tara Bussell at 574.235.9254. <br />OFFICE USE ONLY: <br />Date Received: Fee Paid: Approval Date: <br />