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CITY OF SOUTH BEND , w"" �� 41($ 227 W. JEFFERSON BOULEVARD PHONE 574/ 235-9251 <br />DEPARTMENT OF PUBLIC WORKS 1" SUITE 1316 CouNry Gry BUILDING Fax 574 235-9171 <br />SOUTH BEND, INDIANA 46601 TDD 574/ 235-5567 <br />Street/Alley Vacation Form <br />kawA <br />*THIS FORM MUST BE REVIEWED BY THE CITY ENGINEERING DEPARTMENT PRIOR TO GRANTING A RADIUS MAP* <br />Submission Date <br />1I )� <br />... . <br />_ .....Applicant Name: ..... <br />Phone#: <br />K,k'd4,5 Email: <br />Property <br />p y Address j�G S J <br />'PJe <br />Applicant property information: Residential ❑ Commercial ❑ Industrial <br />Describe the general alley location with boundaries (ex. Ymm <br />Church PI, between E. Colfax Ave & E. LaSalle Ave): <br />41 <br />Is your property adjacent to the alley of interest? Yes No <br />Do you own all adjacent properties to the alley of interest? Yes N <br />If no, use the attached table to provide the following information for all affected property owners: <br />Name, Address, Consent for the proposed alley vacation <br />Reason for street alley vacation and proposed use: s <br />m <br />g Y P garage property ❑ Yes No <br />Does the existing alley provide ara a access to otherowners? <br />Does the alley receive daily traffic excluding your own use? ❑ Yes No <br />Would the vacation hinder public access to any of the following: a church school, or any <br />public ublic buildingplace? lace. ❑ Yes No <br />OFFICE USE ONLY: <br />Board Recommendation for the proposed alley vacation: Yes No, <br />Board of Public Works Authorized Signatures:' d <br />Version 1.0 [6/14/2016] <br />