HomeMy WebLinkAboutTraffic Control Device - Deaf Child AreaVTH
BOARD OF PLIDLIC WORKS
Request for Approval of
` 65 Traffic ControlDevice(s)
Date: December 15 2018 Traffic Request Number: N/A
.._...........
I hereby submit the following installation or change of traffic control devices for review:
. .. ................ ..._...............� m- .. ...............
New Installation ❑ Removal ❑ Revision ..................... -
❑ Stop Sign ❑ Stop Sign ❑ Stop Sign
❑ Yield Sign []Yield Sign ❑ Yield Sign
❑ Speed Limit, _mph ❑ Speed Limit, _mph ❑ Speed Limit, _mph
Other., List ❑ Other, List ❑ Other, List
2 - Deaf Child Area (W2-6H) signs
Location(s): East and west ends of block encompassing 1216 East Jackson Road
This has been submitted:
® In response to request by a citizen/ neighbor/ passerby: Cynthia Victoria-Jaimes (574-807-5693)
❑ In response to contracted reconstruction or improvements
❑ In response to developer -provided reconstruction or improvement
❑ In response to an internally -generated concern from
Remarks: See attached verification and doctor's documents, and location drawing._.............................................ww
Submitted & Proposed by:
OR&U&V-
Theresa E. Harrison, PE, ENV SP
Traffic Engineer
Date: December 17, 2018
APPROVED: SOUTH BEND BOARD OF PUBLIC
WORKS
Gary A. f41ot' resicent
SuzanI M.Frit~r tuber
James --A °Muc flcr; Member
LPLt�, ()' VA
Elizabeth A. Maradik, Member
Therese J 1) wm, Member
Distribution:
Bureau of Traffic and Lighting
South Bend Police Department Traffic Division
Roger T. Nawrot, P.E., P.L.S. - Assistant City Engineer
Attest
Linda NI. Martin, f;I qc
Date
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DEAF CHILD AREA (W2-6H) SIGNS
1216 EAST JACKSON ROAD
necessary. VHILARE'A"
0i lee
City of South Bend Theresa E. Harrison, P.E., ENV SP December 17, 2018
Department of Public Works Traffic Engineer
Engineering Division
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4�44 MAC Vie.
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I request that a deaf child sign be posted within the public right,of way of my place of residence, and I
understand that only one sign per approach is permitted with exact placement to be determined by the South
Bend City Engineer. I also understand that installation could take 90 days from the date of submission.
In support of this request, I hereby certify under pains and penalties for perjury that I am the parent,
guardian, or person responsible for the care of a deaf child under age 13 and in whose home this deaf child
regularly resides. I further certify that the deaf condition of this child has been confirmed by hearing tests or by
a medical professional.
By signing this Request, I agree to immediately notify the City in writing if (i) the family moves from
the area, (ii) the child no longer lives ill the area, and (iii) any conditions related to significant improvement in
the child's hearing; have occurred. I understand the sign will be removed when the child reaches the age of 13.
Date;
Signature _. ..__.�.. ...
Printed Natne and Relationship to Child Mother
574-807-5693*
Phone Number
Na:-VVI.U.YI CAI..YYVC-S
Ghild's Narne
Street Address of Residence for mm. , c
tt Sign Placement
City
and Zip Code
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CAO.... co n/1
Email
Child's llate of Birth
If the above address is not your actual physical residence, then please provide actual address for contact.,
Return this forrri to City of South Bend, Department of Public Works, 1300 N County -City Building, 227 W.
Jefferson Blvd,, South ]..lend, IN 46601
Please make a copy for your records.