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CITY OF SOtJTH BEND <br />DEPARTMENT OF PUBLIC WORKS <br />Street/Alley Vacation Form <br />, t, r 1�"1 4- <br />227 W, JEFFERSON BOULEVARD PHONE 574/ 235-9251 <br />SUFFE 1316 COUNTY -CITY BUILDING FAX 574/ 235-9171 <br />SOUTH BEND, INDIANA 46601 TDD 574/ 235-5567 <br />*THIS, FORM MUST BE REVIEWED BY THE CITY ENGINEERING DEPARTMENT PRIOR TO GRANTING A RADIUS MAP'* <br />Submission Date: <br />Applicant Name: <br />0 <br />Phone #: <br />2 1-6-80 9117 <br />il. <br />Email: <br />a Q Cca <br />Property Address: <br />,� <br />kj, <br />Applicant property information: Residential 0 Commercial D <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 />F-1 Yes 0---N No <br />If no, use the attached table, to provide the following information for all affected property owners: Name, Address, Consent <br />for the proposed alley vacation <br />Reason for street/alley vacation and proposed use: <br />Does the existing alley provide garage access to other property owners? <br />El Yes No <br />Does the alley receive daily traffic excluding your own use? <br />Yes F-1 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 />El Yes 2No <br />OFFICE USE ONLY: <br />Board Recommendation for the proposed alley vacation: El Yes r/No <br />Board of Public Works Authorized Signatures: <br />Version 1.0 [6/14/2016] <br />