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APPLICATION FOR SIDEWALK SALE PERMIT 1
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CITY OF SOUTH BEND, INDIANA 'labs,! Fs
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NEW RENEWAL ❑ DATE (�
PERMIT FEE IS $10.00 PER YEAR ❑ Fee is Paid
Applicant's Legal Name 1�7� ,[� A Y\., 0 & j2S0 /'L' Title
Business Name fr J l
Address
Telephone Number 1 -7
Proposed Location and Description of Sidewalk Sale
Days of Sidewalk Sale peration
Hours of Sidewalk Sale Operation
Type of Goods to be Sold
Dates of Sidewalk Sale
Sun
Mon
Tues
Wed
Thurs
Fri
Sat
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[Note: This Permit may be utilized by the Permittee only for sidewalk sales directly in front of his/her business
establishment. This Permit does not allow the placement of merchandise in front of the business of any
merchant other than the Permittee, unless the properties involved are contiguous and the written consent of the
other merchant is obtained. Permittee must allow for at least five (5) feet of unobstructed sidewalk for the free
flow of pedestrian traffic at all times during the sale.]
AFFIRMATION
1, the undersigned, agree that I will abide by all of the provisions of Section 18-15 of the South Bend Municipal
Code and with all the provisions stated above as conditions of the issuance of this Permit. I further agree to
indemnify, defend and hold harmless the City of South Bend from any liability, loss, cost, damage or expenses,
including attorney fees, which the City may suffer or incur as the result of any use of the public sidewalks for a
sidewalk sale as permitted herein. I do hereby certi and affirm that all the information given in this
applicatio is true the best of my knowledge.4
Date Signature of Applicant
Title of Applicant
BOARD OF PUBI IC WO S APPROVAL
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President Member
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Member
RETURN FORM TO:
Board of Public Works
1316 County -City Building
227 West Jefferson Boulevard
South Bend, IN 46601
Member
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Date
Updated 6/22/12 - I
Phone: (574) 235-9251 a Fax: (574) 235-9171 ♦ E-Mail: publicwks@southbendin.gov