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TRAFFIC CONTROL AND OCCUPANCY REQUEST <br /> City of South Bend – Division of Engineering <br /> 227 W Jefferson Boulevard, Ste 1316 <br /> South Bend, IN 46601 <br />Name of Contractor/Company: <br />Name of Applicant: <br />Phone: Email Address: <br />On-Site Contact: Phone: <br />Requested Dates (mm/dd/yyyy): _______ /_______ /20_______ to _______ /_______ /20_______ <br />Time of Work: _____________________ to ____________________ <br />Location of Work:  Entire Street  Travel Lane  Parking Lane <br />Sidewalk Tree Lawn Alley <br />Type of Work: Excavation/Boring (Also requires Excavation Form) <br />New Drive Approach (Also requires Curb Cut Application) <br />Sidewalk <br />Address of Project: <br />Project Boundaries: <br />Description of Work: <br />Traffic 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 w ork <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. <br />Signature of Applicant: Date: <br />Applications should be dropped off to the City’s Engineering Office or emailed to <br />rowpermitsoffice@southbendin.gov. For questions, contact Tara Bussell at 574.235.9254. <br />DEADLINE: DUE FIVE BUSINESS DAYS PRIOR TO PROJECT START DATE <br />PROJECT INFORMATION <br />OFFICE USE ONLY: <br />Date Received: Fee Paid: Approval Date: <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />APPLICANT INFORMATION