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"'; <br />Application <br />? <br />FOR- <br />ItttilORIC I'll EST;R ATIONC;CJ,MMISslUN' <br />of SOUTH II -END & ST. JOSEfrfl C'Clk.i'ti`C'1 <br />S.1.afwe - A, South Bend 1\1 46601 <br />?:ttP: 'W -w -A stjc pltcott.:tySndi #na,cotztr{fcptzritncnt;<;SJt ICT �iriti� .tTenz <br />p: 5774-235-9798 f..574-235_95718 e- SASJCIIPC'ri'co.st-io-,eph.iii:tis <br />{T 1`11C7ONLY">z»"•> L)0NtYt•Ct1'f.f:T".0 F:WRIPSCONTAINT}TINT ITT", i c<c,�er7lTff't?t%.SF'f3P'I,Y" <br />OateM-r(,ked: _. ,_� S i' C'. `v C Spyslictiiatz titacsxi)rr: ��G r^ t <br />Malt HVI iexY>: El 11-1; ttJ�t$ cf 6cst Re Z; e) _.. _.... ❑ J NO <br />f ) <br />StatTAppm%a}andwriredby-t _.-___._ -._. _,...__.._.w......_._" .i it: <br />fti,twit t'rewn-ition COninik,54 n-ltev;emo trate: <br />❑ Corm Landmark <br />❑ t,ocat ttktoric WitrirI (Naw) -- ...._...... _ _._.. __ .... -- <br />❑ l;ttitf xfAt t..:t❑simark <br />❑ iti:itlf)ma! ItCt�t�tet' t)ikt rtYt ('tiamt) �,�„_.... .___. _ . _.....w..._ _ _........._....__ <br />t,crt}tlCxtr Uf.it t:r{E`)�;3'yYli$CTtt'.i�n: r �•^� <br />❑ Denied �p ( <br />❑ i:ibled ❑ Srrtt'r{i A)Tmmittre ❑ Approved and iikucd' <br />tl�t is ii.S4 f tliit� <br />of Property for proposed p ork......_.. <br />_ i,<�fi,^...._ t i% <br />%.._:':Adfrrs <br />?. .. <br />tr't'L't:�'Lfrr.i.''--.�:Yt'(.'1 :%u"if7C C'ili°-•Tfj1 (, t1f�Ci <br />"datrte of I rt) )ert nems}'tt1_ <br />> t "CTta <br />_e.:�_"'�'r"A E vt-�'.5.,,. C _.t✓.t Phone N: � 14 `7.1,1 - 365' <br />Address (if PropertyO ner#s): C�c(Lz� <br />at ; (;i. Ivsr ftil , �vtii � {sa idti�P �,�t �{ V Uig <br />{Sire: t :'&'rm;P,rr _ Streer:"Llanx - t;in>- lip C"ojej <br />Name of C:ontractor($): { tc r <br />{'� 7 r� t r,�•} - f 1 w : Y (7i:_I_« Y .t tlQtii #: j„_7 Y K7 71 ` f! <br />Contract Coulp..iny ^::r:e: .a_.C...1 .c <br />l . ? r t -.rt? ✓1.�tii.... _ _._._ ,., <br />Address ofContrat Comploy `" `} <br />(' avet Number— si'nrrre t:ina Z,if, C"ttel�J <br />C',arrrtt ['cr mfni6din . .._._..._..................... �3 t tli� �c?........ vSy: ___.............,...... . <br />{.Sinyiz �itr`rtilt•... ,tlttlti-1':urrils�—C`r"ts,7nerx:ia;--C;asert)t)rrrtf—ftr:iustract:' ' �L:Cttrtt—•etc; <br />t'vt)e*ri'ft:titttiagCtnstreetion: C. _.. ........ _........ .......... ___._.._.. ._ ...___ _.....____._.._..__........__.. <br />ttt's,rhld�i�zrrrc •%r;rk StI11s� .�tz�'"k--.C"ortc'rrtr t}tlrerJ <br />Propo.wd Wort.: ❑ to -Kind ❑ Landscape ❑ New ❑ Reptacement (nrtdi-kind) ❑ Dennolition <br />(ertole !hart opic `•or may be i�7:ecAecl) <br />Description of Proposed Work: 5c . ..................—_ <br />t atilq�_�e e.. E vt }q_rsc3tf tt.� �1 ..... rxf%i= L�'`!'WE .'...-s`�.._�.fat,»t r'�st✓j.. <br />_ <br />G&S :Q _ ......... ___...... <br />p. <br />Mah,.a._._ _ :._..' �.__._....__ _ __.... __..... <br />> t gg <br />` ita^trtfl'It• £.. 3>••. .. f a`.} xc�Y' ..;):'k`L P'ti cxi :r( <br />t}pnr,Y/L tnttrattet'Fai.,: <br />r <br />r �iutl t. ri! c'ttrnsft(:f y xt'tth o4' One tfesijyn u) _.. <br />..........._ r <br />iM <br />n�fCtntactorSignaturepj6t ncr `rrntp <br />IS AlIr�x UVERS <br />i Sjils- <br />174 ttCtitE�I� <br />