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CITY OF SOUTH BEND <br />APPLICATION FOR SPECIAL EXEMPTION FROM <br />MANDATORY DOWNSPOUT DISCONNECTION (DDav1) <br />IMPORTANT: <br />Before considering applying for a special exemption property owners must make every effort to <br />disconnect their downspouts from the City of South Bend's Sewer System. Applications will not be <br />considered for properties where the owner cannot clearly demonstrate the steps taken to attempt to <br />disconnect. <br />Only complete this application if you are currently connected via one or more downspout(s). If your <br />downspouts are disconnected or will be before November 23, 2018 for commercial buildings or December <br />31, 2018 for residential, there is no need to complete this application. <br />Only complete this application form if disconnection of the downspouts on your property is not feasible <br />or would create a hazardous condition or safety risk. <br />Contact Information <br />First Name: <br />Last Name: <br />Street Number: <br />Street Name: <br />Suite/Unit #: <br />City: South Bend <br />Zip: <br />Telephone 1: <br />Telephone 2: <br />Email: <br />run iegai name of registered property owner(s). In the case of corporate ownership, a person with the <br />authority to enter the corporation into a legally binding contract may complete. <br />Property Address <br />❑ Property address same as mailing address stated above (if not, please specify below) <br />Street Number: Street Name: Suite/Unit #: Zip Code: <br />1 <br />