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APPLICATION <br />TO ENCROACH ONTO PUBLIC RIGHT-OF-WAY <br />THE BOARD OF PUBLIC WORKS MUST HAVE FOUR (4) WEEKS PRIOR NOTICE <br />PLANS AND SPECIFICATIONS MUST BE ATTACHED <br />Date: December 18, 2019 <br />Location of Encroachment: <br />See attached; multiple locations <br />PROPERTY -OWNER'S INFORMATION <br />Business/ <br />Homeowner <br />South Bend Public Transportation Corporation <br />Name: <br />(Transpo) <br />Address: <br />1401 S. Lafayette Blvd <br />City/State/Zip: <br />South Bend, IN 46613 <br />Phone <br />574 232 9901mm Email shill rtrtr°ansp.oiii <br />Signature <br />m <br />Print Name: <br />Amy Hill <br />_ <br />INSTALLER'S INFORMATION <br />Business Name: Burkhart <br />Address: 1247 E. Mishawaka Ave <br />City/State/Zip: South Bend, IN 46615 <br />Phone 574-236-5615 Email <br />Signature <br />Attach Photo of Site <br />Here <br />(Or See Attached Photo) <br />Print Name: <br />_......_............................... .... ..w,... ....... ..... ___....- ­.. <br />Encroachment <br />Description: Installation of bus shelters garbae cans and bike racks at various locations <br />Size of <br />CL Road to R/W Line Encroachment <br />Distance of R/W Amount in R/W <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 />....... �. ,.,----------.. ...... <br />This Encroachment shoul <br />d not 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 />° OA D Lii Ic OUR APPROVAL <br />. .. ... _.._ ... .. <br />President Mem er G1 t rt er <br />er 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 />