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CITY OF SOUTH BEND <br />DEPARTMENT OF PUBLIC WORKS <br />Street/Alley Vacation Form <br />227 W. JEFFERSON BOULEVARD PHONE 574/ 235-9251 <br />-CITY BUILDING FAX -9171 <br />`�1111'11' SUM 1316 COUNTY 574/235 <br />to <br />SOUTH BEND, INDIANA 46601 TDD 574/ 235-5567 <br />"TIMS FORM MUST BE REWEVIED BY'THE CITY ENGINEERING DEPARTmFNT PRIOR TO GRANTING A RADIUS MAID* <br />Submission Date: <br />Applicant Name: <br />Phone#: <br />Email <br />Z5 <br />Property Address: <br />Applicant property information: Residential E] Commercial <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 />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/alley vacation and proposed use: 7-0 <br />74.� <br />Does, the existing alley provide garage access to other property owners? <br />El Yes Jg No <br />Does,'the alley receive daily traffic excluding your, own use? <br />E] Yes ;K 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 ;eN 0 <br />OFFICE USE ONLY: <br />Board Recommendation for the proposed alley vacation: Yes _. n N <br />Board of Public Works Authorized Signatures: Avul. atA.- <br />Version 1.0 [6/14/2016] <br />