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At,I'I,I(A I'ION <br />TO kNt:'Etr:)M l l ONTO PI1l3E C RIGI IT-01'-WAY <br />W IWAIM(Ml 11 FIMAC'1VORKS MINT FIA V V 1 t:J1M (4) WF.EKs ]'itiojt ym, r, <br />PLANS AND SPIl(MM:nMMS Iv1t.;s't° Be A I'rrlc 11 .) <br />I vld 11 . . , , , <br />Location of I?lic.1-oachruentl�� <br />i'IZOPEA(TY-OWNEWS INFORMATION <br />l3C€'Sln; m N+li ec L104eo <br />Address: I Z5 J 1� ae.•."[.._,. __..........._ ....................._........ <br />t`€f�tltilatcr"/..11l:--�ty11�4 � <br />Signaturc <br />Print N,1t m ' <br />INSTALLEWS INFO1ItMA`I'ION <br />13ushwu Narllc : <br />Addrcs : Yu <br />City/Stalefl',Y Sit, <br />Ia.lcrc�achntcest _ �. _ <br />Description: <br />Cl.Size, of, <br />Road to R/W LAC ient <br />Distance of R/�4' Amount in RIW <br />Attach Photo of Site <br />Here <br />(Or See Attached ]'halo) <br />The above € kwntalion €S ul the W of rlty k€lox0 dge ,accurste m d c0€wo with regard it) flit; encroach€ima in Ow Myl rl N-ot- <br />%Qw. <br />I'itls.i;cl BY: _ JOA ej <br />This l llcruaclnnc.rli shtsldtl not be <br />rolocalcd because <br />II Ilan hewn dutcl In nital that this cilcro€1ch€lle€it 111 no way i m pair,, tIic I€€gl1way or WIIIt Ilse. Iree and Sii1l Ilim of Iralfic therelm, ant] <br />it is recommended Ilia( the encroachment be hl:rmitted to remain. <br />I () R .) c}I J I.1C' W )IZ J AI 1 ROVAL t <br />>> <br />Prisidcttt mcillber i tel3iher <br />t IcE3r per l�tcnit�t�.l• <br />Date <br />RETURN I'"t?Itill'I'O: 2 <br />Board cif € ublic Works <br />1.316 l'oaltfy-C:ily Iil€ildia4 <br />227 I' eA Jcl']i<rson Boulevard <br />S(udh Berl, IN ViOl <br />Phony 074) 2119251 a M (524) 7359171 a t.':-A-Iail: I�ilB4iceck�(ri3suultt6undtai�'ov <br />