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APPLICATION <br />TO ENCROACH ONTO PUBLIC RIGHT-OF-WAY ""°•wee <br />TILE BOARD OF PUBLIC WORKS MUST HAVE FOUR (4) WEEKS PRIOR NOTICE <br />PLANS AND SPECIFICATIONS MUST BE ATTACI IED <br />Date: 01/17/2020 <br />Location of Encroachment: Northeast corner of Angela Blvd and Riverside Intersection <br />PROPERTY -OWNER'S INFORMATION <br />Business/ <br />Homeowner <br />Name: <br />City of South Bend Venues Parks & Arts <br />Address: <br />301 S. St. Louis Blvd, <br />City/State/Zip: <br />South Bend, IN 46617 ..................W_.�...._-� _....�..�....... <br />Phone <br />k <br />`0�35 q_' Entail caf <br />Signature <br />�� <br />y.. _......_.- .... <br />Amy 6br�# <br />Print Name: <br />M <br />INSTALLER'S INFORMATION �...�.. <br />Business Name: <br />City of South Bend Venues Parks & Arts <br />Address: <br />301 S. St. Louis Blvd. <br />City/State/Zip: <br />South Bend, IN 46617 <br />a Email <br />Phone <br />mail !� t" <br />,35 931 �,V . <br />Signature <br />Print Name: Amy M Roush <br />Encroachment <br />Attach Photo of Site <br />Here <br />(Or See Attached Photo) <br />Description: Inslallalion by Venuos Parks & Arts as ado naled projed from the Noho dame 1070 Class as a 50Ih reunion project which will include 3 Black Gum trees, a Sculpture shovel hand le,and Rock <br />........... .... .. .....w,Y... ,.w..e�.. ....-...�..._.Y— —------------ . ............... . . m........ <br />Size..,..� ... .........._....,..���.� <br />of <br />CL Road to R/W Line Encroachment <br />Distance of R/W _ Amount in R/W <br />Attached you will find several documents that l hope will y p help explain the layout. <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.- Amy M Roush <br />This Encroachment should 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 />) r i APPROVAL <br />� <br />w �IC 1�i� " <br />..tlN& cMember.... _. <br />Preskdet <br />Ember <br />RETtfRN 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 />