Laserfiche WebLink
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: / /2019 <br />-- 250 feet east of Bertrand Street/Eclipse <br />Place Intersection. Well coordinates <br />Location of Encroachment: 41 ,681486 N, 86.288188 W <br />PROPERTY -OWNER'S INFORMATION <br />Business/ <br />Homeowner <br />Name: Curtis ProWducts,, lnc <br />Address: 401 N. 'Bandix Dr. <br />City/StateJLip: South Bend, IN 46628 <br />Phone 5 i'4.289-48'9l Email <br />Signature II,, <br />Print Name: 3��nvi Mer-krgynAo <br />INSTALLER'S INFORMATION <br />Business Name: <br />Address: <br />City/State/Zip: <br />Phone <br />Signature <br />Print Name: <br />Encroachment <br />Description: <br />Ho�rll ilnteraatlonal <br />3520 Weslmoor St <br />South B=djN 46628 <br />574 231- 000 Email <br />w1VG[C �-� ei��•� <br />6-inch extraction well to 5 feel below sorface jpde <br />Size of Approximately 6x6 <br />CL Road to R/W Line Approximately 25 feet south of center line Encroachment <br />Approximately 1 ft from southern edge of 100 % within grass shoulder, 0% <br />Distance of R/W eastbound side of road to sidewalk Amount in R/W within Bertrand Street <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: Groundwater & Environmental Services Inc. <br />This Encroachment should not be <br />relocated because Because of site utilities and 0 dtniq to road and sidewalk. <br />It has been determined that this encroachment 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 />)VAL <br />Member <br />Date. .... _ <br />RETURN FORM TO: <br />Board of Public Works <br />1316 County- ty Building <br />227 West Jefferson Boulevard <br />South Bend, IN 46601 <br />Phone: (574) 23 5-9251 a Fax: (574) 235-9171 <br />