Revised CITY DOCUMENTS PROCEDURES AND PROGRAMS - Downspout Disconnection Program

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Eligibility Criteria To be eligible for consideration for an exemption under South Bend Code of Ordinance, Chapter 17-4 (C) 1 or 2 the Applicant must meet the following requirements: 1. The Applicant must be the legally registered owner of the property; 2. The Applicant must provide all of the documentation required in this application; and 3. Disconnection of the downspouts on the property from the City sewer must, in the determination of the Department of Public Works, with the approval of the Board of Public Works, create a hazardous condition or not be technically feasible. Terms 1. Where the documentation submitted by an Applicant is insufficient, it shall be returned. 2. The Applicant shall provide the City with access to the property to verify the information contained in the application and to determine eligibility for an exemption. 3. Neitherthe completion and submission to the City of this application by the Applicant, nor the review by the City of this application shall constitute the granting of an exemption. The granting of an exemption shall be by the Board of Public Works. 4. An exemption previously issued may be revoked where any information provided in the application or in support of the application by the property owner(s) or any person on his or her behalf is false, misleading or inaccurate in whole or part. S. The City reserves the right to revise the application form or the exemption process from time to time. The City reserves the right to amend, modify or revoke the exemption provided under South Bend Code of Ordinance, Chapter 17-4 (C) 1 or 2 as it deems appropriate. Declaration In order for your application to be reviewed, all information must be provided. In addition, City staff may inspect your property to verify the information provided; by submission of this application you grant permission to City staff to enter onto your property for inspection/verification purposes. I am the registered owner of the subject property and certify that the information contained in this application, and all other attached/enclosed documentation is accurate and true in all respects*. Signature Print Name (Full Legal) Date (mm-dd-yyyy) *In the case of ownership by a corporation or business entity, a person with the authority to bind the owner may submit this application. Please submit the completed application by mail: City of South Bend Mandatory Downspout Disconnection Program 227 W Jefferson Blvd # 1316 South Bend, IN 46601.