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N <br />City of South Bend Public Works u <br />Engineering Division a 52 <br />227 W. Jefferson, County City Building 1316C <br />South Bend, IN 46601-1830 <br />CURB CUT APPLICATION <br />Phone: 574.235.9251 <br />Fax: 574.235.9171 <br />Email:rowpermitsoffice@southbendin.gov <br />Requires 3 WORKING days minimum for review by Engineering Division prior to Construction <br />Submission Date: / .z• Z -7 Applicant Name: /-/09rr4 C+-j-T/.��c �r■� E ��,Q.•cy <br />Contact Information (Phone and Email): .?/.2 - yS-�f�.t,S ,� �.rvi fie•+ , G o <br />Property Address: alS' X71 ,f d� ,��,,., _ZA/ Gin / lyr.y el,14 c. <br />�o,f�•9 <br />Type of Curb Cut: <br />❑ Residential Driveway ❑ Commercial Driveway - 24' Maximum Width ❑ Alley Approach - 14' Typical Width <br />❑ 10' (Single) <br />j El 16' (Max Width) Industrial Driveway - 30' Maximum Width <br />� <br />Complete each item: <br />1. Does the existing lot meet setback requirements for the governing district? [+eYes ❑ No <br />2. For lots being improved, has a variance been granted from the Board of Zoning Appeals? <br />RN/A ❑ Yes ❑ No <br />3. Are there any intersections within 50' of the proposed residential drive? ❑ Yes 2r No <br />(Industrial approach requires 100' distance from intersections) <br />Provide Proximity <br />4. Are there any obstructions near the drive? (i.e light poles, hydrants etc.) If so, list <br />here: ❑ Yes 0 No <br />5. Does the existing property have access to garage via an alleyway? ❑rYes v No <br />6. Does the proposed work meet clear sight area requirements? R Yes ❑ No <br />Additional Comments: <br />Drawing of proposed work must be included with this application <br />"Contractor bonded with Public Works shall pull a permit for construction work in the Right of Way <br />ENGINEERING OFFICE USE ONLY: <br />❑Approved [—]Approved as Noted ❑Denied as Noted ❑Traffic Study Required <br />Comments: <br />Date- <br />Engineering Division Authorized Signature <br />-New engineering review and approval required after 3 months if no permit has been issued for work - <br />Version 2.1 [1/15/20211 <br />