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ENCROACHMENT APPLICATION <br />f� City of South Bend - Board of Public Works <br />227 W . Jefferson Boulevard, Ste. 1316 <br />2865 <br />South Bend, IN 46601 <br />PROPERTY OWNER INFORMATION: <br />Name of Business/Homeowner: Bakery Group, LLC <br />Address: 908 Portage <br />City/State/Zip: South Bend IN 46616 <br />Phone:574 220-8867 cell Email: 9kil@kilarchitecture.com <br />ENCROACHMENT INFORMATION: <br />Location of Encroachment: Portage Ave <br />Encroachment Description <br />New Step Encroachment (3 locations) over ROW <br />CL Road to R/W Line: 30' at Avenues, Size of Encroachment: 6'-8' x 0'-6" +/- <br />Distance of R/W: 60' w at Avenues Amount in R/W: 6'-8' X 0'-611 +/- <br />INSTALLER'S INFORMATION: <br />Business Name: Bakery Group, LLC, Owner <br />Address: 1012 Riverside Drive <br />City/State/Zip: South Bend, IN 46616 <br />Phone:574 514-2096 cell Email: <br />Signature: <br />Printed Name: Mike Keen <br />mfkeenl@gmail.com <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />0 Photos of the area where encroachment will take place. <br />0 Plans and Specifications <br />0 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 />2__C- <br />Signature of Applicant: Date: Sep 18, 202, <br />Printed Name of Applicant: Gregory Kil <br />