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Date: <br />APPLICATION <br />TO ENCROACH ONTO PUBLIC RIGHT-OF-WAY <br />Tim BOARD OF PUBLIC WORKS MUST HAVE FOUR (4) WEEKS PRIOR NOTICE <br />PLANS AND SPECIFICATIONS MUST BE ATTACHED <br />10/26/2016 <br />Location of Encroachment: 209 North Main <br />PROPERTY -OWNER'S INFORMATION <br />Business Name: Great Lakes Capital Development <br />Address: 112 <br />City/State/Zip: <br />Blvd. Suite 200 <br />IN 46601 <br />Signature I A71V <br />Print Name: /fin d AA <br />INS ER'S INFORMATION <br />Business Name: H.G.R. Group Inc. (General Contractor) <br />Address: 1918 E. Jefferson Blvd. <br />City/State/Zip: South Be 6t 17 <br />Signature i <br />Print Name: <br />Encroachment <br />Description: <br />H. G. Reinke <br />CL Road to R/W Line <br />Attach Photo of Site <br />Here <br />(Or See Attached Photo) <br />Glass and steel entrance canopy, 12'-0" above sidewalk <br />Size of 7-9"W x 26'-8"L <br />50 feet Encroachment x P-4"D <br />Distance ofR/W 100 feet total R/W width <br />in R/W Entire canopy <br />The above information is to the best of my knowledge accurate and correct with regard to the encroachment in the City's right-of- <br />way. <br />Placed By: <br />Owner (Great Lakes Ca <br />The canopy will be integral to the aesthetic of the renovated fagade, as well as <br />This Encroachment should not be away to mark the public entrance and protect visitors and occupants from the <br />relocated because elements as they enter and exit. <br />It has been determined that this encroachment in no way impairs the highway or with the free and safe flow of traffic thereon, and <br />it is recommended that the encroachment be permitted to remain. <br />AixOARD OF PUBLIC WORKS APPROVAL <br />President MelYber Member <br />tFV ✓ � 1,��2�-�lca <br />RETURN FORM TO: 2 <br />Board of Public Works <br />1316 County -City Building <br />227 West Jefferson Boulevard <br />South Bend, IN 46601 <br />Phone: (574) 235-9251 • Fax: (574) 235-9171 9 E-Mail: publicwks@southbendin.gov <br />