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Ito <br />� a <br />F <br />'ru^� APPLICATION FOR PLACEMENT OF <br />HONORARY SIGN AND OTHER HONORARY FEATURE <br />WITHIN THE PUBLIC RIGHT-OF-WAY OR ON PUBLIC PROPERTY <br />' <br />ForOfice Use Only: �Application Complete 1 f'ce Receivved 6'etition Complete . . <br />❑ APPROVE ❑ DENY <br />1. <br />ApplicantnNinformation <br />An- <br />r <br />A licant's Address � �'. �j�f � s � �� � � t� � � Date., 3 � i < < <br />..a,l <br />Email Address; 1P honc• g Zf , �3zo, <br />2. Honorary Sign or Feature Request:.J3 (ms o Do tA d L <br />Proposed Location: 'we, s, -c- `0 A ka N r- Example l: Corner of North and South Street Example <br />2: Alum . tr etmfra�nt Ist Street (0 3rd Street) �j� /� � 1, 1 S o n <br />Significance of Location to Honoree's Life— Vl immY� LV - fj <br />3. Required Submittals: <br />Please submit the following items along with your request: <br />✓ A jyped statement of not less than 500 words describing the s ,gt ,ificall of the person being honored. <br />The statement should include detailed information about the proposed Honoree summarizing the <br />Honoree's accomplishments, and reasons as to why the person should be publically recognized. <br />✓ A petition of rt for the proposed Honorary Sign or Honorary Feature. The petition should be <br />signed by ttQ(less....tlt n fift ( ) residents of the City of South Bend and must include the name, <br />address, signature and date of signing. The petition should be witnessed by one individual and must be <br />notarized prior to submittal. [Note: All information on the petition must be l,emmgjm 4 in order to be <br />considered.] <br />Upon submission of this Application, please allow four (4) weeks for staff to review, and presentation to the <br />City's Board of Public Works for final action. A letter will be sent to the Applicant indicating the Board's <br />decision. In the event that the Application is denied, the Fee will be refunded to the Applicant. <br />4. SIGNATURE OF APPLICANT <br />My application consists of the following items: (Please check) <br />Completed Application l"orm plus one (1) copy !Do . o0 2, S'ic) rns <br />100.00 Application Fee (Make check , payable to: City of South Bend) <br />8 pdd statement describing the 5jgrdifk4jjgg of the person being honored <br />&`Petition of Support <br />4P errrtua^e Date � <br />Printed Name <br />FA�inb ihA \9a�nd�k. Mcmbcr 1 drvn� t,ihcrs, �Icmbc� <br />A]FISK <br />/ <br />h'.mA C5f me <br />Joseyl R 1I 1nu, Nombcr _ <br />Linda IL ylnrlin, CIerF <br />*SqS <br />