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ENCROACHMENT APPLICATION <br />z City of South Bend - Board of Public Works <br />Si `f !I - <br />-= 227 W . Jefferson Boulevard, Ste.1316 <br />' South Bend, IN 46601 <br />PROPERTY OWNER INFORMATION: <br />Name of Business/Homeowner: Jinya Ramen Bar <br />Address: 1145 N Eddy St STE 140 <br />City/State/Zip: South Bend, IN 46617 <br />Phone:260-438-8993 Email: kdevoss@rise-advisors.com <br />ENCROACHMENT INFORMATION: <br />Location of Encroachment: 1145 N Eddy St STE 140 <br />Encroachment Description <br />Blade sign to be installed <br />CL Road to R/W Line: Napolean St <br />Size of Encroachment: 40" <br />� <br />Distance of R/W: I Amount in R/W: 40" <br />INSTALLER'S INFORMATION: <br />Business Name: Hayes Design Co <br />Address: 1247 Mishawaka Ave <br />City/State/Zip: South Bend, IN 46615 <br />Phone:574-236-5615 Email: dbaker@hayesdco.com <br />Signature: <br />Printed Na <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATI <br />❑ Photos of the area where encroachment will take place. mr—unvo <br />❑ Plans and Specifications <br />E"-'a 13 2024 <br />ElCompleted Agreement <br />AFFIRMATION `'1 bULIV11iI`I <br />I, the undersigned do hereby certify and affirm that all the informaotio og�eP i�� i1 is` <br />application is accurate and correct. I understand that encroachments must in noway impair <br />the highway or free and safe flow of traffic thereon and may be revoked at any time. <br />Signature of Applicant: �U'Uo 1 0 Date: 9-19-24 <br />Printed Name of Applicant: Dana Baker - <br />