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CITY OF SOUTH BEND <br />DEPARTMENT OF PUBLIC WORKS <br />Street/Alley Vacation Fo'rm <br />k'rF1 <br />aw 227 W. JEFFERSON BOULEVARD PHONE 574/ 235-9251 <br />SUITE 1316 COUNTY -CITY BUILDING FAX 574/ 235-9171 <br />Z", <br />SOUTH BEND, INDIANA 46601 TDD 574/ 235-5567 <br />7 <br />'71-16 FORM MUST BE REViEVIED BY THE CITY ENGINEERING DEIRARTMEN'r PRIOR TO GRANTING A RADIUS MAP* <br />Submission Date: <br />Applicant Name: <br />FPhone # rekv,, h : <br />Email: <br />VA h(22 C-0 M <br />Property Address: <br />C] 'S e, IAkY3,- 1/1 A Lx Z, <br />Applicant property information: Residential F] Commercial Inclustrial[ <br />Describe the general alley location with boundaries, (ex. <br />Church PI, between E. Colfax Ave & E. LaSalle Ave <br />�,N)n r - �- 1t oA k,f, <br />Y2— 6 <br />0ii +C:', yz toe d AJ <br />Is your property adjacent to the alley of interest? Yes No <br />Do you own all adjacent properties to the alley of interest? F] Yes 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/ailley vacation and proposed use: <br />0 L 0, 0 Chp to 0 <br />r. IJ 0 e- <br />A Q^ QlwS I A) 1,5' 0 <br />k.opr the PAsting'-'a'lley provide garage acchs to other property owners? <br />E] Yes � No <br />Does the alley receive daily traffic excluding your own use? <br />E] Yes 12No <br />Would the vacation hinder public access to any of the following. a church, school, or any <br />11_1� <br />n Yes P No <br />other public building or place? <br />OFFICE 'USE ONLY: <br />Board Recommendation for the proposed alley vacation: F❑E No <br />Yes <br />Board of Public Works Authorized Signatures: <br />Version 1,0 [6/14/2016] <br />1 0 ve. (' ) <br />