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APPLICATION <br />To ENCROACH ONTO PUBLIC RIGHT-OF-WAY <br />THE BOARD OF PUBLIC WORKS MUST HAVE FOUR (4) WEEKS PRIOR NOTICE <br />PLANS AND SPECIFICATIONS MUST BE ATTACHED <br />Date: 6/28/2018 <br />Location of Encroachment: 119 North Michigan Street <br />PROPERTY -OWNER'S INFORMATION <br />Business/ <br />Homeowner <br />Name: <br />JCD Holding LLC <br />Address: <br />2226 TreysTrail <br />City/State/Zip: <br />Mishawaka, IN. 46545 <br />Phone <br />574-250-3777 Email Jeremy 0cnotius, shushi,com, <br />Signature <br />Print Name: <br />Jeremy Young <br />INSTALLER'S INFORMATION <br />Business Name: <br />Accelerated Service LLC <br />Address: <br />23526 C.R, 4 <br />City/state/zip: Elkhart, IN. 46514 <br />Phone 574-310-0241 Email wdahlnen@comcast,net <br />Signature <br />Attach Photo of Site <br />Here <br />(Or See Attached Photo) <br />Print Name: Bill Dahmen <br />Encroachment <br />Description: Utilities (Gas, Meters relocation, existing are in basement of Coney Island Bar) <br />Size of <br />CL Road to R/W Line Sidewalk Easement See attached pictures Encroachment 10'x 12' <br />Distance of R/W Amount in R/W <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-way. <br />Placed By: <br />This Encroachment should not be <br />relocated because <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 it is <br />recommended that the encroachment be permitted to remain. <br />R%qBLI=S APPROVAL,/A <br />Al-" -— —.4 <br />President Member '-elnbW <br />-7 12 q <br />Member Member Date' <br />RETURN FORM TO: <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 9 Fax: (574) 235-9171 <br />