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.rH .. PLACEMENT OF HONORARY SIGN AND OTHER HONORARY FEATURE <br />WITHIN THE PUBLIC RIGHT-OF-WAY OR ON PUBLIC PROPERTY <br />w €�� APPLICATION, <br />pw tc, City of South Bend - Board of Public Works <br />°•. x try <br />227 W. Jefferson Boulevard, Ste.1316 <br />South Bend, IN 46601 <br />r For Office use <br />Only: Comments: <br />L <br />❑ Application Complete ❑ Fee Received Petition Complete <br />APPLICATION INFORMATION <br />Applicant's Name: <br />Applicant's Addres! <br />❑ APPROVE <br />Email Address: CJ+�7 �.t jW5�W�7o"/. Tele hone: ' <br />cdm <br />Honorary Signor Feature Request Name (Sign should read): jubi7 <br />Proposed Location: C-d4' S�- wav daw <br />Example: Main Street from 1st Street to 3rd Street <br />Significance of Location to Honoree's Life: <br />DENY <br />0 <br />ulta <br />Public <br />APPLICATION CHECKLIST A R�nt of St. Joseph County, IN <br />Please submit the following items along with your request: Commission No. 6 fires 0My Commission Expires 06/23/2024 <br />Completed and signed application. — - - <br />✓ <br />0�1 l Gi l'' �ZI/ l <br />$100.00 Application Fee (make checks payable to: City of South Bend) jr1 �I�G�L <br />✓ A typed statement of not less than 500 words describing the si nificance of the person being <br />honored. The statement should include detailed information about the proposed Honoree <br />summarizing the Honoree's accomplishments, and reasons as to why the person should be <br />pub] icaIly recognized. <br />✓ A petition of support for the proposed Honorary Sign or Honorary Feature. The petition <br />should be signed by not less than fi� residents of the City of South Bend and must <br />include the name, address, signature and date of signing. The petition should be witnessed by <br />one individual and must be notarized prior to submittal. [Note: All information on the <br />petition must be legible in order to be considered.] <br />Upon submission of the Application, please allow four (4) weeks for staff to review, and <br />presentation to the City's Board of Public Works for final action. A letter will be sent to the <br />applicant indicating the Board's decision. In the event that the Application is denied, the Fee will be <br />refunded to the Applicant. <br />SIGNATURE OF APPLICANT <br />Signature <br />Printed Name <br />a, — <br />Date <br />