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APPLICATION <br />TO ENCROACH ONTO PUBLIC RIGHT-OF-WAY <br />THE BOARD OF PUBLIC WORKS MUST HAVE FOUR (4) WEEKS PRIOR NOTICE <br />PLANS AND SPECIFICATIONS MUST BE ATTACHED <br />Date: February 6, 2019 <br />Location of Encroachment: 350 E. Lasalle Avenue <br />PROPERTY -OWNER'S INFORMATION <br />Business/ <br />Homeowner <br />Name: Commerce Center Lie; vkn)niettit, LLC <br />Address: 401 E. Colfax Avenue -- Suite 277 <br />City/State/Zip: South Bend / IN / 46617 <br />Phone 571 60-8008 t."Inal Per itw�cmalthewsde� com _._. <br />Signature ' " <br />g Pi l <br />Print Name: David Matthews <br />INSTALLER'S INFORMATION <br />Business Name: 1Construction C�� a nily <br />��Wgltcgptt�- <br />Address: 3914 Prospect Street <br />City/State/Zip„ <br />lndianaEolis / IN / 46203 _ <br />kl,q ,a:Iull,J. ir+cr I r ,-ti111W,:.u..... <br />Phone <br />317-359-5411 Email t <br />Signature�a`!��. <br />-.. <br />Print Name: <br />Kurt Schlebecker <br />Encroachment <br />................................ --- ......................--...... _..... —......---_....,....-............................. <br />Description: <br />p <br />alon, Lasalle Avenue <br />Fresh air intake shafts --------------- <br />CL Road to R/W Line 41.25 feet <br />Distance of R/W 82.5 feet <br />See Attached Photos <br />Size of <br />Encroachment <br />Amount in R'W <br />trsr� <br />East: 1'-0" by 22'-7" <br />West: 1'-0" by 16'-,8". <br />East: 1'-0" by 22'-7" <br />West: 1'-0" by 16'-8" <br />The above information is to the best of my knowledge accurate and correct with regard to the encroachment in the City's right-of-way. <br />Placed By: <br />This Encroachment should not be <br />relocated because <br />It has been determined that this encroaclunent in no way impairs the highway or with the free and safe flow of traffic thereon, and it is <br />recommended that the encroachment be permitted to remain. <br />AIt1) J <br />.at1 �� APPROVAL <br />-� �.... ......._� ....u__ — — <br />President Member Member <br />_ _. ._ ..--�.�,� .......l_..� <br />Member Member Date <br />RETURN FORMTO: <br />Board of Public Works <br />1316 Comity -City Building <br />227 West Jefferson Boulevard <br />South Bend, IN 46601 <br />Phonc: (574) 235-9251 0 Fat: (574) 235-9171 <br />