Long Term Occupancy - Burton City Sidewalks- Ancon Construction

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City of South Bend/Public Works 215 S. Dr. Martin Luther King Jr Blvd South Bend, IN 46601 Application and Permit Long Term Occupancy of City Right-of-Way Applicant: Ancon Construction Applicant Address: 2121 W. Wilden Ave Goshen, IN 46528 Date: 4/24/2026 Project Site Address: 2614, 2616, & 2626 Main St. and 109 E. Eckman St. South Bend, IN Note: Occupancy limited to street(s) immediately in front of construction site. Nature and extent of Occupancy (e.g.: proposed construction activities, equipment proposed to occupy public right-of-way, construction deliveries, etc.): Construction project to build a new laundromat and replace city sidewalks along Main St. and Eckman. Duration of Occupancy: May through September 2026 � ..... 11'!'0.,.� Signature of Applicant: __ G_le_n_K_a_u_ff_m_a_n_n_�::-_'l_�:--'_.�_;F"_.:r-_· _-_-_-_=_~·_'�_··_-_ THE TERMS AND PROVISIONS OF CHAPTER 6, ARTICLE 5 and CHAPTER 18, ARTICLE 7, Sec 18-62 OF THE SOUTH BEND MUNICIPAL CODE ARE INCORPORATED HEREIN IN THEIR ENTIRETY. FAILURE TO COMPLY WITH THESE PROVISIONS SHALL RESULT IN CANCELLATON OF THIS PERMIT. THIS PERMIT SHALL BE CONDITIONED UPON THE EXECUTION AND FILING WITH THE BOARD OF PUBLIC WORKS OF A BOND IN AN AMOUNT APPROVED BY THE BOARD OF PUBLIC WORKS, CONDITIONED TO INDEMNIFY, SA VE AND KEEP HARMLESS THE CITY OF SOUTH BEND, IN DIANA, FROM ANY AND ALL LOSS, EXPENSE, COST OR LIABILITY OF ANY KINDS WHATSOEVER WHICH THE CITY MAY SUFFER OR BE PUT TO FROM OR BY REASON OF ANY ACT OR THING DONE OR NEGLECT TO BE DONE, OR BY VIRTUE OF THE AUTHORITY GIVEN IN SUCH PERMIT. TO BE COMPLETED BY CITY STAFF ONLY: Bond/Fee Amount: $ 17,930 / $1,100 Date Bond/Fee Filed: 4/24/2026DCompliance with CH 6, ART 5 and CH 18, ART 7, Sec 18-62 of the South Bend Municipal Code D Fee Paid Date Issued: _4/28/2026 BOARD OF PUBLIC WORKS President Member Member Member V 1.11.19 X X Issued By: Madeline H -ostetler Permit Manager April 28, 2026