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,� '���;�; ENCROACHMENT APPLICATION <br />City of South Bend - Board of Public Works <br />227 W . Jefferson Boulevard, Ste.1316 <br />;N. South Bend, IN 46601 <br />PROPERTY OWNER INFORMATION: <br />Lincoln Bendix Park Neighborhood Association In4 <br />Name of Business/Homeowner: <br />Address: 2514 Kenwood Ave. <br />City/State/Zip: South Bend/Indiana/46628 <br />Phone:5742339887 Email: marilyngachaw@aol.com <br />ENCROACHMENT INFORMATION: <br />Location of Encroachment: 400-500 Block of Meade Street/Bendix Dr. within the ,� � I <br />Encroachment Description: Plant a Native Garden in three bare sections to beautit4 <br />CL Road to R/W Line: .5 , 5 Size of Encroachment: 3 as <br />Distance of R/W: `T Amount in R/W: Cif! 3� S�• <br />INSTALLER'S INFORMATION: <br />Business Name: Naturally Native Nursery <br />Address: 20525 Johnson Road <br />City/State/Zip: South Bend/Indianal46628•- Lko (o t - <br />Phone:419-833-2020 Email: nnn@naturallynative.net <br />Signature: <br />Printed Name: <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />19 Photos of the area where encroachment will take place. <br />B 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 noway impair <br />the highway or free and safe <br />�flow <br />yof traffic/thereon and maybe revoked at anytime. <br />Signature of Applicant._ I ,�_ I{�*���� Date: <br />Printed Name of Applicant: n 1_+ Ld M 11 1A e2 In 6 U — _ <br />