Occupancy and Traffic Control Request

Application Summary

This form starts as the Traffic Control and Occupancy Request form and incorporates several other permit request forms as appropriate to your project's needs. It includes:

Excavation Permit Request Form
Sewer Tap Request Form (for within City limits)

In answering questions, you will be directed to the appropriate sub-forms to complete the application process. After submitting the form, a member of the City of South Bend Engineering team will reach out with next steps.

Application Checklist:

To complete the Traffic Control and Occupancy Request Form, you will need:

Traffic Control Plan
Communications (door hanger, letter, signs) notifying residents
Contact information for any subcontractors that work with you on this project.

Will your project take longer than 90 days to complete?

YesNo

If your project takes longer than 90 days to complete, you must instead complete the Request for Long-Term Occupancy Form.

Name of Contractor/Company

Name of Applicant

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

On-Site Contact

First NameLast Name

On-Site Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Is this a City project?

YesNo

Input the Project Number

Is this for a City program?

YesNo

What program is it for?

Requested Start Date (MM/DD/YYYY)

MonthDayYear

Requested End Date (MM/DD/YYYY) (must be within 90 days of the start date).

MonthDayYear

Daily Start Time

Hour Minutes

AM/PM Option

Daily End Time

Hour Minutes

AM/PM Option

Address of Project

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Project Boundaries

Description of Work

Plans and Specs

Communication (letter, door hanger, signs, etc.) to affected property owners

Location of Work

Type of Work

Excavation / BoringNew Drive ApproachSidewalkSewer

Do you have subcontractors?

YesNo

Are you going to have traffic restrictions for any part of this project?

NoYes, Everyday.Yes, some days and will note on the plan what days

What type of restriction?

FlaggingPartial road closureFull road closureOther

Will these traffic restrictions take place outside of work hours provided on the application or on the weekends?

YesNo

Do you have a traffic control plan with a detour route that you will be attaching to this permit?

Yes, I have a traffic control plan and detour route that I will attach below.No, a third party is doing my traffic control plan and I understand I need to send the plan to rowpermitsoffice@southbendin.gov once they have it completed before the office will review my permit application.

Traffic Control Plan including detour map and traffic devices

Failure to use traffic control for traffic restrictions or closures will result in stop work orders and/or delay in permitting. This Occupancy Permit Request is non-transferable. A signature subjects the named contractor/permittee to all applicable rules, duties and obligations imposed by the South Bend Municipal Code and to all regulations imposed by the City’s Board of Public Works. For questions, contact the Permit Manager at 574.235.9254

Occupancy and Traffic Control Request

Application Summary

Application Checklist:

Applicant Information

Project Information

Excavation Permit Request

City Limits Sewer Tap Permit Request

New Drive Approach Pre-Approval

Driveway Specifications and Standards

Permit Fees for Construction in the Right of Way:

List ALL other Subcontractors

Finalize Submission