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CITY OF SOUTH BEND <br />DEPARTMENT OF PUBLIC WORKS <br />Street/Alley Vacation Form <br />F _ 227 W. JEFFERSON BOULEVARD PHONE 574/235-9251 <br />SUITE 1316 COUNTY -CITY BUILDING F" 574/235-9171 <br />SOUTH BEND, INDIANA 46602 TDD 574/235-5557 <br />Submission Date: <br />Applicant Name: . <br />Phone#: <br />Email•!,� <br />Property Address: <br />.,ID <br />Applicant property informatio ❑ Residential Commercial <br />Industrial <br />Describe the general alley location with boundaries (ex. <br />Church PI, between E. Colfax Ave & E. LaSalle Ave): <br />Is your property adjacent to the alley of interest? <br />Yes ❑ No <br />Do you own all adjacent properties to the alley of interest? <br />Yes No <br />If no, use the attached table to provide the following information for all affected property owners: <br />Name, Address, Consent for the proposed alley vacation <br />Reason for street/alley vacation and proposed use: <br />Does the existing allef provide garage access to other property owners. <br />❑ Yes No <br />Does the alley receive daily traffic excluding your own use? <br />Yes ❑ No <br />Would the vacation hinder public access to any of the following: a church, school, or any <br />other public building or place? <br />❑ Yes No <br />OFFICE USE ONLY: <br />Board Recommendation for the proposed alley vacation: ❑ Yes— XNo <br />Board of Public Works Authorized Signatures: <br />'V(6ga,TIcv) <br />ck.& � , <br />s <br />Version 1.0 (6/14/20161 <br />