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APPLICATION <br />TO ENCROACH ONTO PUBLIC RIGHT-OF-WAY <br />THE BOARD OF PUBLIC WORKS MUST HAVE FOUR (4) WEEKS PRIORNOTICE <br />PLANS AND SPECIFICATIONS MUST BE ATTACHED <br />Date: 10-21-2020 <br />Location of Encroachment: 201 S Main Street - 46601 <br />PROPERTY -OWNER'S INFORMATION <br />Business/ <br />Homeowner <br />Name: <br />Bald Mountain, LLC <br />Address: <br />21953 Protects Drive <br />City/State/Zip: <br />Elkhart, IN 46516 <br />Phone <br />js oke@greatlakescapital.com <br />Signature <br />,,�'� ����JJ <br />/ <br />Print Nam <br />/e: 4 7,)Q 14K / I' 0,1/- iQ <br />INSTALLER'S INFORMATION <br />Business Name: <br />Burkhart Sign Systems <br />Address: <br />1247 Mishawaka Ave <br />City/State/Zip: <br />South Bend, IN 46615 <br />Phone <br />Signature <br />Print Name: <br />Encroachment <br />Description: <br />CL Road to R/W Line <br />Distance of R/W <br />rjohnson burkhartsigns.com <br />Ric and Johnson <br />YtiL7�3TF1 �. <br />L <br />PLEASE SEE FOLLOWING <br />2-PAGES <br />Vertical Blade sign attached to NE corner facade <br />Size of <br />40' - 8" (Jefferson Blvd) Encroachment 3' - 0" <br />83.25' (Jefferson Blvd) Amount in R/W 3' - 0" <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 />BOARD OF PUBLIC WORKS APPROVAL <br />BOARD OF PUBLIC WORKS <br />Gmy A. GJot, President Tbemae J. Dome, Member - November 10, 2020 <br />Date <br />Elisabeth A. M-dik, Member Jordan V. Goths., Member <br />p YZ ATTEST: <br />RETURN FORM TO: <br />�nadr CRlmmr <br />Joseph RMolnar, Member Board of Public Works <br />Linda M. Martin, Clerk 1316 County -City Building <br />227 West Jefferson Boulevard <br />South Bend, IN 46601 <br />Phone: (574) 235-9251 • Fax: (574) 235-9171 <br />