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ENCROACHMENT APPLICATION <br />�y; = City of South Bend - Board of Public Works <br />227 W . Jefferson Boulevard, Ste. 1316 <br />South Bend, IN 46601 <br />PROPERTY OWNER INFORMATION: <br />Name of Business/Homeowner: Beauty Suites on Summit,LLC/Shalonna T. Diggins <br />Address: 319 S. Summit Drive <br />City/State/Zip: South Bend IN 46619 <br />Phone: (974)21-226g Email: beautysuites3190Pgmail.com <br />ENCROACHMENT INFORMATION: <br />landscape area on the right hand side of the entryway into the parking <br />Location of Encroachment: jqt Z the qin <br />woula We to nave a bigh R61511uu jacing multumn so dlenw coming off of WesternAve- a d <br />Washington can see the foCation of the building. The sign wits he 40in. and will be on a wooden post - <br />Encroachment Description: ut <br />to show the distance between the sign and rhv. <br />CL Road to R/W Line: 27.5ft/324.5in Size of Encroachment: 40in <br />Distance of R/W: <br />4ft/48in Amount in R/W: 0 <br />INSTALLER'S INFORMATION: <br />Business Name: Self installation <br />Address: <br />N/A <br />City/State/Zip: N/A <br />Phone: N/A Email: N/A <br />Signature. NIA <br />Printed Name: N/A <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />❑ Photos of the area where encroachment will take place. <br />❑ Plans and Specifications <br />❑ Completed Agreement <br />AFFIRMATION <br />I, the undersigned do hereby certify and affirm that all the information given in this <br />application is accurate and correct. I understand that encroachments must in no way impair <br />the highway or free and safe flow of traffic thereon and may be revoked at any time. <br />Signature of Applicant: —�� Date: 08/21 i2n9.s <br />Printed Name of Applicant: Shalonna T. Diggins <br />J it <br />