Milieu LicensePermits, made clearer
Independent permit preparation. View the official source for South Bend.
Find a permit/Streets & utilities
Permit preparation

Consent to Annexation

Public Works Engineering · South Bend, Indiana

Editable official PDF

Edit the agency’s original form, save your draft, attach documents, and review your completed PDF before signing or ordering delivery.

Print and mail service is available for your prepared packet. Review the destination and the agency’s acceptance requirements before ordering. Government payment is separate from document and postage charges.

Notarial acknowledgment required; no verified current postal/application route in source. Do not infer acceptance from the hold-recorded-copy instruction.

Official form and instructions
Your application steps6 steps · Public Works EngineeringView steps
  1. 1Prepare your answersComplete here

    Edit and save your answers on the official PDF.

    Official source
  2. 2Add supporting documentsComplete here

    Attach the supporting records listed by the agency. Check that every page is legible and complete.

    • Owner signature and notarized acknowledgment
    • City Board of Public Works approval
  3. 3Review and signPrepare here, finish outside

    Complete each applicable applicant signature after reviewing the full declarations. Required notary, professional and witness signatures remain separate.

  4. 4Choose paymentPrepare here, finish outside

    Original acknowledges water/wastewater system development charges and applicable wastewater surcharge; amount depends on usage and agency review. Do not apply the separate$150 annexation-petition fee to this utility consent. Government fees are separate from the optional prepared PDF and postage. Review the exact amount and recipient before authorizing a check.

  5. 5Submit or order deliveryPrepare here, finish outside

    This consent permits a future annexation and waives the owner’s remonstrance rights for property connecting to City utilities. Review the full original before signing. Property owner execution must be acknowledged before a notary. Notary certification, subscribing-witness details and Board approval are completed by those parties, not by the applicant.

    Official submission instructions
  6. 6Keep your receiptComplete here

    Save your agency confirmation and payment receipt. Track any mailing from My applications. Delivery does not mean the agency approved your application.

Official requirements and sources
  • Official source

    Page2 requires notarial acknowledgment and Board approval. Original widget B18 is incorrectly typed as Signature at commission-expiry line; excluded rather than treating it as applicant signature.

Complete your application

Required fields are marked *. Fields follow the agency’s published form. Save your work before leaving this page.

Fill in the official form

Select a highlighted blank and type directly. Use Field list for larger controls and any answers that need a continuation page.

Page 1 of 2 · 8 editable blanks
Hold Recorded copy for: Board of Public Works CONSENT TO ANNEXATION, WAIVER OF RIGHT TO REMONSTRATE AND ACKNOWLEDGMENT OF MISCELLANOUS CITY FEES In consideration for permission to tap into the municipal utility system (water and/or sewer) of the city of South Bend, Indiana, in order to provide sanitary sewer and/or water service to the following described property, (hereinafter referred to as the "Real Estate"), situated in St. Joseph County, Indiana. Property Owner 1 Property Address Tax ID/Key # Legal Description Water/Sewer Mailing Address Phone/Email owner(s) of the Real Estate, (hereinafter "Owner"), for themselves and their successors in title, assigns, and personal representatives, hereby irrevocably waive and release any and all right which they may now or hereafter have to remonstrate against or otherwise interfere with, or oppose any pending or future annexation of the Real Estate by the City of South Bend. In further consideration and to induce the City of South Bend to allow Owner to tap into the municipal utilities (sewer and/or water) of the City of South Bend, Owner, for themselves and their successors and assigns, agrees and stipulates irrevocably to vest in the City of South Bend the permanent right, at the City's discretion, to annex the Real Estate at any future time by duly authorized ordinance. Owner further agrees that any deeds, contracts, or other instruments of conveyance made by Owner, their successors or assigns shall contain the waiver and release provisions contained herein, which provisions shall run with the land. Pursuant to Chapter 17, Article 10, Sections 17-79 and 17-80 of the South Bend Municipal Code, Owner acknowledges and accepts the Owner’s obligation to pay a wastewater and water system development charge based on expected usage. Further, the Owner acknowledges and agrees to pay the applicable surcharge established under Chapter 17, Article 10, Section 17-81 for wastewater service. The delivery of any instrument of conveyance from the Owner to any successor, grantee, vendee or contract purchaser is subject to the terms of this document and the acceptance of such instrument shall constitute an acceptance of the foregoing provisions by said grantee, vendee, or contract purchaser and their successors in title.

Select any highlighted blank to type. A larger copy of the selected question appears here.

Review every page before signing. Professional, agency and notary signature areas stay reserved.Original blank form