Laserfiche WebLink
APPLICATION* J' <br />TO ENCROACH ONTO PUBLIC R[GHT-OF-WAY ^" <br />THE BOARD OF PUBLIC WORKS MUST HAVE FOUR (4) WEEKS PRIOR NOTICE' <br />PLANS AND SPECIFICATIONS MUST BE ATTACHED pan, <br />Date: December 2, 2019 <br />Location of Encroachment: South Street Station — 100 W. South St <br />PROPERTY -OWNER'S INFORMATION <br />Business/ <br />Homeowner <br />South Bend Public Transportation Corporation <br />Name: <br />('T'ransoo) <br />Address; <br />1401 S. L al`'irve'tte Blvd <br />City/State/Zip: <br />South Bend, IN 46613 <br />Phone <br />r 1 .91 mail nhtgllr sl tattosi�o,aatm <br />4 ,_.,... 90E <br />..-__ ,,... <br />Signature <br />Print Name: <br />G M 1 <br />INS"I"ALLER`S INFORMATION <br />' <br />Business Name: Mc Group <br />Address; 8959 Tyler Blvd <br />City/State/Zip: Mentor, OH 44060 <br />-------- <br />P. (440) 209. <br />6200 ext. 155 <br />II F: (440) 209- tmIk%Pbc 1P,1(a tlq t t11zjP' qQ <br />Phone 6276 email m <br />Signature <br />Print Name: Mike Phelps <br />Encroachment <br />Description: kA -T <br />CL Road to R/W Line ADD 'TWO APIAtJ POSTS W/Sit41,15 <br />1-) nir,im aww <br />Attach Photo of Site <br />Here <br />(Or See Attached Photo) <br />. Size of „ .:.. .... .:_ ., ,.. <br />Encroachment 1 11 <br />�YrIllllnl ui It1W <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 no t 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 />D OF 1' .CBI IC WORKS APPROVAL <br />........... . ...... . . . ..... <br />esidel t �...M. ember Member <br />tuber 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 • Fax: (574) 235-9171 <br />