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PLACEMENT OF HONORARY SIGN WITHIN THE PUBLIC RIGHT-OF­ <br />WAY OR ON PUBLIC PROPERTY APPLICATION <br />City of South Bend -Board of Public Works <br />227 W. Jefferson Boulevard, Ste. 1316, <br />South Bend, IN 46601 <br />APPLICATION INFORMATION Applicant's Name: \ �('�� �Applicant's Address: s= i o ; C \c,1 h Rat . Email Address: yY)10.. .. h'b,-t'...D1 \� �3-1r1CL1 {,{c,,--,relephone/Cell: <br />Honorary Sign Request: <br />Honorary Sign Request Name (sign should read): Su mu. f'. k 1)'';J s ,'',,_r y. sJ. <br />(St., Blvd., Ln., Etc.) <br />Is this individual deceased? l, Yes _ No (if no, individual is not eligible for honorary sign.) <br />If the Board approves the petition, the petitioner must pay two hundred and 00/100 ($200) per sign to be manufactured and installed by City er:nployees. The City will neither approve or install more than four ( 4) Honorary Street Signs per Honoree. <br />Proposed Location( s): <br />Location #1: Intersection of_G=c�VZt_t'}�· �+--· ___ & t).e \ QWC,\y-S( <br />Location #2: Intersection of �·[s,_=· __ VZ...�V\'---"'-+-__•__& __ (-=-4=_·-......\_v-e,.:.....;:;..._vl-.:;_· _ <br />Location #3: Intersection of __,.G .... a...""-...... v .... 7;"'-'VI'-'--+--'----- & -+;\ ,�D ..... , a.,_l"'-',:....:a=----n._c:-__ <br />Location #4: Intersection of ________ & _______ _ <br />(Example: Intersection of North Ii South Street) <br />Did the individual live in South Bend? � _ No (if no, individual is not eligible for honorary_ sign.) <br />Significance of Location to Honoree's Life: C hi) vi.. h Yto-\d2->� � ovex 36"'"�-(){\. �V\,+ 9 - <br />REQUIRED SUBMITTALS <br />Please include the following items along with your request: ✓A statement of not less than 500 words describing the significance of the person being honored. Thestatement should include detailed information about the proposed Honoree summarizing the Honoree'saccomplishments, connection to South Bend, Indiana, and reasons as to why the person should bepublicly recognized.✓A petition or support for the proposed Honorary Sign. The petition should be signed by not less than 200residents of the City of South Bend and must include the name, address, age, signature, and date ofsigning. [Note: All information on the petition must be legible in order to be considered.]Upon submission of the Application, please allow eight (8) weeks for staff to review, and presentation to the City's Board of Public Works for final action. A letter will be sent to the applicant indicating the Board's decision. In the event that the Application is denied, the Fee will be refunded to the Applicant.