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ENCROACHMENT APPLICATION <br />City of South Bend - Board of Public Works <br />-` 227 W . Jefferson Boulevard, Ste.1316 <br />South Bend, IN 46601 <br />PROPERTY OWNER INFORMATION: <br />Name of Business/Homeowner: Bradley Co -St Joseph Station <br />Address: 300 N Michigan St <br />City/State/Zip: South Bend, IN 46601 <br />Phone:574-986-9269 Email: bhadzimesic@bradleyco.com <br />`ENCROACHMENT INFORMATION: <br />Location of Encroachment: NE Corner of Michigan St & La Salle Ave <br />Encroachment Description: Blade Sign <br />CL Road to R/W Line: La Salle Ave/Michigan St Size of Encroachment: 36" <br />Distance of R/W: <br />Amount in R/W: <br />36" <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: G'tJ <br />Printed Name: Dana Baker <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: - <br />❑ Photos of the area where encroachment will take place. nctibVE1 <br />❑ Plans and Specifications DEC 18 2024 <br />❑ Completed Agreement <br />LAY Di 3AWUi Dow <br />AFFIRMATION owl, of�PA"Nerkig <br />I, the undersigned do hereby certify and affirm that all the information given En <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 />Signature of Applicant: Date: <br />Printed Name of Applicant: Dana Baker _ <br />