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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: Januar 3, 20E7 <br />Location of Encroachment: 3 <br />Mishawaka Avenue <br />PROPERTY -OWNER'S INK)R <br />Business/ Zion Castor dba Castor Liquidation LLC <br />Homeowner <br />Name: <br />Address: 733 S. 33'1 Street <br />...... _... ............ .. _................. _ <br />City/State/Zip: South Bend, IN 46615 <br />Phone 541-255-5544 ._._.. Email casto�rli uidatim iqui i on <br />_._. _.,ail.com <br />Signature <br />Print Name: Zion Castor <br />INSTALLER'S INFORMA" <br />Business Name: Custom Awning <br />Address: 1251 Third Street <br />Osceola, IN 46561 <br />Phone 574-674-5900 Email customawninginc <br />,., y'ahoo.com <br />Signature <br />Print Name: Jacr eline Beals <br />Encroachment <br />Description: <br />CL Road to R/W Line <br />Distance of R/W <br />Storefront Awning <br />26' <br />Attach Photo of Site <br />Here <br />(Or See Attached Photo) <br />Size of <br />Encroachment <br />2' <br />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 />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 />� OAi D OF It JC WORK APPROVAL <br />President Member t n7lber <br />Member 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 a Fax: (574) 235-9171 <br />