Fillable Application and Permit Long Term Occupancy of City (City of South Bend)

Fill Online, Printable, Fillable, Blank Application and Permit Long Term Occupancy of City (City of South Bend) Form

Use Fill to complete blank online CITY OF SOUTH BEND (IN) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Application and Permit Long Term Occupancy of City (City of South Bend)

On average this form takes 5 minutes to complete

The Application and Permit Long Term Occupancy of City (City of South Bend) form is 1 page long and contains:

  • 1 signature
  • 2 check-boxes
  • 14 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of South Bend

BROWSE CITY OF SOUTH BEND (IN) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Application and Permit
Long Term Occupancy of City Right-of-Way
Applicant: _______________________________________________________ Date: _________________
Applicant Address: ________________________________________________________________________
Project Site Address: _______________________________________________________________________
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.):
____________________________________________________________________________________
____________________________________________________________________________________
Duration of Occupancy: ___________________________________________
Signature of Applicant: _____________________________________________
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, SAVE AND KEEP HARMLESS THE CITY OF SOUTH BEND, INDIANA, 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: $ _____________ Date Bond/Fee Filed: ___________________
Compliance with CH 6, ART 5 and CH18, ART 7, Sec 18-62 of the South Bend Municipal Code
Fee Paid
Date Issued: ___________________ Issued By: __________________________________________
BOARD OF PUBLIC WORKS
___________________________________________
President
___________________________________________
Member
___________________________________________
Member
___________________________________________
Member
City of South Bend/Public Works
227 W. Jefferson Blvd
South Bend, IN 46601
V 1.11.19
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Application and Permit Long Term Occupancy of City (City of South Bend)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 16 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document