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.4 rIN` ENCROACHMENT APPLICATION <br />4m L City of South Bend - Board of Public Works <br />f 227 W . Jefferson Boulevard, Ste.1316 <br />%'rZ1-:2t <br />-' South Bend, IN 46601 <br />PROPERTYOWNER INFORMATION: <br />Name of Business/Homeowner: Krak Boba <br />Address: 1234 Eddy St Ste 126 <br />City/State/Zip: South Bend, IN 46617 <br />Phone:574-210-0947 Email: hOn9tran@gmail.com <br />ENCROACHMENT INFORMATION: <br />Location of Encroachment: 1234 N Eddy St Ste 126 South Bend, IN 46617 <br />Encroachment Description: Blade Sign <br />CL Road to R/W Line: Napoleon St <br />Distance of R/W: 16' <br />INSTALLER'S INFORMATION: <br />Business Name: Hayes Design Co <br />Address: 1247 Mishawaka Ave <br />Size of Encroachment: 38.5" <br />Amount in R/W: <br />City/State/Zip: South Bend, IN 46615 <br />Phone:574-236-5615 Email: dbaker@hayesdco.com <br />Signature: [;� U - j &&'—) <br />Printed Name: Dana Baker <br />38.5" <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />❑ Photos of the area where encroachment will take place. RECEIVED <br />❑ Plans and Specifications <br />❑ Completed Agreement <br />c .-' 2 3 2024 <br />AFFIRMATION j" (Nbouln bow <br />I, the undersigned do hereby certify and affirm that all the infhcg:if, 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 trafficiithereon and may be revoked at any time. <br />Signature of Applicant: kj[L) Date:9-19-24 <br />Printed Name of Applicant: Dana Baker <br />