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ENCROACHMENT APPLICATION <br />`n City of South Bend - Board of Public Works <br />yJ 227 W . Jefferson Boulevard, Ste.1316 <br />South Bend, IN 46601 <br />PROPERTY OWNER INFORMATION: <br />Name of Business/Homeowner: Greater New Vision Missionary Baptist Church Inc <br />Address: 1923 Lincolnway West <br />City/State/Zip: South Bend, IN 46628 <br />Phone:574-532-8724 Email: kidzkompanyinc@aol.com <br />ENCROACHMENT INFORMATION: 71 <br />Location of Encroachment: 1923 Lincolnway West <br />Encroachment Description: Canvas awnings <br />CL Road to R/W Line: <br />Size of Encroachment: 3' and 4' <br />Distance of R/W: 54' Amount in R/W: T and 4' <br />INSTALLER'S INFORMATION: <br />Business Name: Custom Awning <br />Address: 1251 Third Street <br />Citv/State/Zia: Osceola, Indiana 46561 <br />Phone:574-674-5900 Email: customawninginc@yahoo.com <br />Signature: <br />Printed Name: Jacqueline Beals <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />® Photos of the area where encroachment will take place. <br />8 Plans and Specifications <br />B 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 safeftw of trVic.ergpn and maybe revoked at anytime. <br />#!jSignature of Applicant - Dategoh d 1 ^ -3 - Y <br />Printed Name of Applicant: �� <br />