Utility Verification Form

  • Utility Verification Form

    City of South Bend - Department of Public Works

  • Use this form to establish a new South Bend Municipal Utility account and calculate System Development Charges (SDCs), if applicable to your development.

    Upon submission of this form, the Right-of-Way Permit Office will reach out for payment of the application fee, or inform you if there are no utilities available for connection.

    This is not a permit. The applicant must first provide all information below and pay all necessary fees.

    The applicant's contractor must obtain a Right-of-Way Permit, Excavation Permit, and Water and/or Sewer tap permits prior to connecting to the City.

    Note: Water tap permits are obtained through Water Works at the following address: 

    915 S. Olive St,
    South Bend, IN 46619

  • Property Information

    To be completed by applicant

  • Property: New Development or Redevelopment

  • A new development property is one that has not had utility connections before.

    A redevelopment property is one that has had utility connections in the past, but it needs new or modified connections.

     

  • Property is a*

  • Property Follow-up Questions

  • New or modified connections to municipal water and sewer may require a System Development Charge (SDC) based on South Bend Municipal Code Chapter 17, Article 10.

    The following questions will help City staff calculate the SDC and ensure adequate services are available at your site.

  • Request a new water connection*
  • Is there existing water service for this property?*
  • For redevelopment project, request a new water connection*

  • Flow Rate Calculation

  • * 310 gallons per day = 1 Equivalent Residential Unit (ERU).

    For residential properties, ERUs = # of units.

    For non-residential properties, refer to 327 IAC 3-6-11 to calculate gallons per day and attach calculations with this form.

    If development falls outside IAC categories, attach stamped flow calculations showing gallons per day

  • Are you increasing the meter size?*

  • For residential properties, the minimum meter size is 1 in.

  • Request a new sanitary sewer connection (must conform to City standards)*
  • Reuse existing sewer tap (subject to approval by the City)*
  • Request fire supression*
  • Request new irrigation line*
  • Property Type*
  • Will the property discharge any non-domestic wastewater? (e.g., cooling water, processing water)*
  • Is the Property Site within City Limits?*

  • Once your application is reviewed and your City boundary status is confirmed, you must also fill out a waiver of remonstration to annexation agreement. 

    This will be sent to your email on file from rowpermitsoffice@southbendin.gov, with instructions on how to complete it.

     

  • Properties Outside City Limits: Contiguous

  • For the following question, select whether or not the project site is 1/8 contiguous. This can be defined as having 1/8 of the property bordering the City boundary.

    Click here to view a map of City limits

  • Is the project 1/8 contiguous?*

  • Annexation Needed

    Properties 1/8 contiguous with the City limits are required to annex into the City before connecting to utilities. 

  • You must also fill out an annexation application form: LINK

  • You must fill out the Consent to Annexation form: LINK

  • Agreement

  • By executing this Utility Verification Form, you hereby acknowledge the statements contained herein are true and accurate. If the City later determines that you misrepresented any statement on this Utility Verification Form, you will be charged the corrected City connection fee. You understand the requirements to connect to City utilities as set forth under South Bend City Ordinance and agree to meet the requirements set forth above. The Contractor will coordinate first with ROW Permits Office for right-of-way permits and then with Water Utility Office for the tap permit.

  • Clear
  • Date
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  • Format: (000) 000-0000.
  • Should be Empty: