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*Certificate of Appropriateness from the Historic
Preservation Commission is required
City of South Bend Permit Application for
Free Standing Sign
Property Address:
Parcel ID: Zoning:
Northeast Neighborhood Overlay: Historic District:
Variance or Special Exception
Approval Date (if applicable):
Applicant Information
Contact Person:
Phone Number: Email:
Mailing Address:
Business Information
Business Owner:
Phone Number: Email:
Mailing Address:
Contractor Information
Contact Person: Company Name:
All Contractors must be licensed and/or registered with our department.
For more information: https://southbendin.gov/department/community-investment/building/
Sign Information For more than 3 signs, please attach additional pages or provide information on the artwork pages
Location on Property: Illumination: Separation:
(To which Street is the sign oriented?)From another freestanding sign on site (ft)
Type: Pole Monument Yard Multi-tenant
Sign Size:
Height (ft) Width (ft) Sign area (sq ft) Height from grade (ft)
Setbacks: Clearance:
Front (ft) Corner (ft) Side (ft) Rear (ft) From Grade (ft)
Location on Property: Illumination: Separation:
(To which Street is the sign oriented?)From another freestanding sign on site (ft)
Type: Pole Monument Yard Multi-tenant
Sign Size:
Height (ft) Width (ft) Sign area (sq ft) Height from grade (ft)
Property Information Sign #1 Yes No Yes* No Sign #2 Information can be found on the Zoning Map at: https://southbendin.gov/zoning
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Front (ft) Corner (ft) Side (ft) Rear (ft) From Grade (ft)
Setbacks: Clearance:
Location on Property: Illumination: Separation:
(To which Street is the sign oriented?)From another freestanding sign on site (ft)
Type: Pole Monument Yard Multi-tenant
Sign Size:
Height (ft) Width (ft) Sign area (sq ft) Height from grade (ft)
Setbacks: Clearance:
Front (ft) Corner (ft) Side (ft) Rear (ft) From Grade (ft)
Free Standing Sign Permit Checklist: ☐1. Completed Application☐2. Artwork, including:☐a. Sign Dimensions☐b. Overall Height☐c. Clearance
☐3. Site Plan including:☐a. Property lines☐b. Streets/alleys abutting property☐c. Location of driveway☐d. Dimensioned setbacks to sign
☐4. Foundation Detail
I, have read and agree to the following:
1.The City of South Bend (the “City”) shall be indemnified and held harmless by the Owner from any claims, damages,
liabilities, losses, actions, suits, or judgments which may be brought, presented, sustained, or obtained against the City
or its officials because of negligence of the sign hanger, contractor, or its agents, or by reasons of defects in the
construction, or damages resulting from the collapse or failure of any sign.
2.The Owner will guarantee removal of the sign when the use which it identifies, instructs, attracts, guides, or
advertises is terminated at that location; however, this will not apply to periodic changing of the sign faces for present
or future tenants or owners. If the Owner is not the owner of the real property on which the sign will be placed, the
Owner represents that the installation of the sign is authorized by the property owner.
3.The Owner shall maintain the sign by repainting peeled surfaces and replacing inoperative components. Should the
Owner fail to maintain the sign as outlined herein within forty-five (45) days after written notice, the City shall remove
the sign after first giving the owner of the sign thirty (30) days written notice of its intent to do so.
Applicant/Owner/Leasee Name Printed Date
Completed applications should be submitted via one of the following:
Email: zoning@southbendin.gov or
Mail: to 227 W. Jefferson Blvd., Suite 1400S, South Bend, IN 46601
*Total fees are based on sign size and will be provided at approval.Sign #3