HomeMy WebLinkAboutLong Term Occupancy Permit - Horizon Construction GroupApplication and Permit
Long Term Occupancy of City Right-of-Way
Applicant: _______________________________________________________ Date: _________________
Applicant Address: ________________________________________________________________________
Project Site Address: _______________________________________________________________________
Note: Occupancy limited to street(s) immediately in front of construction site.
Nature and extent of Occupancy (e.g.: proposed construction activities, equipment proposed
to occupy public right-of-way, construction deliveries, etc.):
____________________________________________________________________________________
____________________________________________________________________________________
Duration of Occupancy: ___________________________________________
Signature of Applicant: _____________________________________________
THE TERMS AND PROVISIONS OF CHAPTER 6, ARTICLE 5 and CHAPTER 18, ARTICLE 7, Sec 18-62 OF THE
SOUTH BEND MUNICIPAL CODE ARE INCORPORATED HEREIN IN THEIR ENTIRETY. FAILURE TO COMPLY
WITH THESE PROVISIONS SHALL RESULT IN CANCELLATON OF THIS PERMIT.
THIS PERMIT SHALL BE CONDITIONED UPON THE EXECUTION AND FILING WITH THE BOARD OF PUBLIC
WORKS OF A BOND IN AN AMOUNT APPROVED BY THE BOARD OF PUBLIC WORKS, CONDITIONED TO
INDEMNIFY, SAVE AND KEEP HARMLESS THE CITY OF SOUTH BEND, INDIANA, FROM ANY AND ALL LOSS,
EXPENSE, COST OR LIABILITY OF ANY KINDS WHATSOEVER WHICH THE CITY MAY SUFFER OR BE PUT TO
FROM OR BY REASON OF ANY ACT OR THING DONE OR NEGLECT TO BE DONE, OR BY VIRTUE OF THE
AUTHORITY GIVEN IN SUCH PERMIT.
TO BE COMPLETED BY CITY STAFF ONLY:
Bond/Fee Amount: $ _____________ Date Bond/Fee Filed: ___________________
Compliance with CH 6, ART 5 and CH18, ART 7, Sec 18-62 of the South Bend Municipal Code
Fee Paid
Date Issued: ___________________Issued By: __________________________________________
BOARD OF PUBLIC WORKS
City of South Bend/Public Works
227 W. Jefferson Blvd., Suite 1316
South Bend, IN 46601
V 1.11.19
November 23, 2021
November 23, 2021