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Right-of-Way Long Term Occupancy Application

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.

PDF lists former227W.Jefferson address; current engineering page does not explicitly verify mail/email application acceptance for this form.

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.

    • Executed bond in the amount approved by Board of Public Works
  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

    Occupancy fee varies by roadway class, closure type and duration. Board-approved bond amount is separate. The currently linked schedule lists arterial/collector closures at$75/day/lane, lane restrictions at$50/day/lane, non-traffic restrictions at$35/week; local closures at$75/week,lane restrictions$35/week,non-traffic restrictions$20/week. Agency confirms applicable charges. 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

    Occupancy is limited to streets immediately in front of the construction site. Board-approved bond must be executed and filed. Leave the staff-only bond, fee, issuance and approval sections blank. Contact the Permit Office at574-235-9254 for the bond form and current submission instructions.Official fee schedule accepts checks toCity of South Bend,but check mailing and amount require confirmation.

    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

    Form reserves bond/fee amount and approval fields for city staff; requires Board-approved bond.

  • Official source

    Current instructions provide Permit Office phone for bond form, but not this form’s postal submission method.

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 1 · 6 editable blanks
City of South Bend/Public Works 227 W. Jefferson Blvd South Bend, IN 46601 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 Member President Member Member V 2.1 [1.15.21]

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