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o�sourx 8d C. <br />227 W. JEFFERSON BOULEVARD U d' PHONE 574/235-9251 <br />SUITE 1316 COUNTY -CITY BUILDING ' PEACE FAX 574/ 235-9171 <br />SOUTH BEND, INDIANA 46601 x x TDD 574/ 235-5567 <br />1865 <br />CITY OF SOUTH BEND <br />DEPARTMENT OF PUBLIC WORKS <br />I 'Z0141► LOU 40A 1 <br />*FAX OR MAIL FORM 3 WORKING DAYS (EXCLUDES WEEKENDS) BEFORE REQUIRED 48 FIR PUBLIC NOTICE <br />**48 HR PUBLIC NOTICE ANNOUNCED UPON APPROVED FORM <br />***THIS APPLICATION EXPIRES 30 DAYS FROM SUBMISSION DATE <br />Oversize ❑ Overweight ❑ Hazardous Material ❑ Superload <br />Z l i; L4 <br />Submission Date: <br />February 5, 2024 <br />Applicant Name: <br />Lykowski Construction, Inc. <br />Phone #:574-291-8858 <br />Fax #: <br />Email: kathylykowski@aol.com <br />Application #: <br />Route: <br />From: <br />North Pumping Station, 830 N. Michigan St., South Bend, IN 46601 <br />To: <br />History Museum, 897 Thomas St., South Bend, IN 46601 <br />Travel Date: <br />TBD <br />❑ Single Lane Occupancy Multi -Lane Occupancy <br />Time(s): <br />From: 9:00 a.m. <br />To: 11:00 a.m. <br />Contact: <br />Kathy Lykowski <br />Phone # 574-291-8858 <br />Load Description: <br />Navarre Log Cabin - 20'-9" in width x 19'0" in length x 19'-4" height <br />Length:48 FT 0 IN Width: 20 FT 9 IN Height: 24 FT 0 IN <br />Vehicle Description: <br />Weight (Gross:) 42,000 Max Weight (Single Axle): - zee - 7, 9dO — i�L <br />Number of Axles: Axle Spacing: 1 �.r�pe Rear Steerable Axle: 9 Yes ❑ No <br />Vehicle Type: ❑ Tractor -Trailer ❑ Truck -Trailer R Truck 0 Other/Towed <br />Has the route been driven previously? <br />If so, provide the date. <br />Yes ❑ No Jan. 16, 2024 & previously <br />Will the load be delivered within the City? <br />If so, consult Ordinance Section 21-07.05. for regulations. <br />R Yes ❑ No <br />Attach the following: M Route Map 0 Axle configuration for vehicles over 5 axles <br />For County route permit contact: 574-235-9626 For INDOT route permit contact: 219-325-7523 <br />OFFICE USE ONLY: <br />❑ Approved V Approved as Noted ❑ Revise ❑ Revise as Noted <br />Comments: Engineering has reviewed and approved the route listed below. With the additional <br />communication to INDOT, beacon health, and other impacted entities, the City approves the application <br />Engineering Division Authorized Signature: Date: <br />CITY OF SOUTH BEND, INDIANA <br />OAR�DOF PUBLIC WORKS <br />B <br />Oversize/Overweight/Hazardous permits requires anon -refundable payment of $35 made pay. V�/� <br />% <br />Superload permits requires a non-refundable payment of $50 made payable to the City of Soul Eliznbeth A. Maradik, President <br />Gary A. Gilot, Member <br />Payment Method: ❑ Credit Card ❑ Check ❑ Cash M rtay L. MillegyM b r <br />3/15/2024 <br />�7r1 <br />Breana N. Mi—, Member <br />Attest Laura D. Hensley, Acting Clerk <br />Date: March 26 2024 <br />