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- -I "' ,...: ENCROACHMENT APPLICATION <br />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: North Central Indiana Food Bank <br />Address: 702 Chapin Street <br />City/State/Zip: South Bend, IN 46601 <br />(574) 232-9986 Email: <br />ENCROACHMENT INFORMATION: <br />Location of Encroachment: 702 Chapin Street <br />Encroachment Description: <br />CL Road to R/W Line: 60 ft. <br />Distance of R/W: 20 ft. <br />Sign located in R/W <br />(INSTALLER'S INFORMATION: <br />Business Name: US Signcrafters, Inc. <br />Address: 216 Lincolnway East <br />Size of Encroachment:148" inches <br />Amount in R/W: 148" inches <br />City/state/Zip: Osceola, IN 46561 <br />Phone:574.674.5055 Email: dmerritt@ussigncrafters.com <br />Signature: <br />Printed Name: Doug Merritt <br />_INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />8 Photos of the area where encroachment will take place. <br />8 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: <br />Printed Name of Applicant: Doug Merritt <br />Date: 5/28/2024 <br />