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ENCROACHMENT APPLICATION <br />City of South Bend - Board of Public Works <br />�2, 227 W . Jefferson Boulevard, Ste. 1316 <br />' South Bend, IN 46601 <br />PROPERTY OWNER INFORMATION: <br />Name of Business/Homeowner: Real Services Housing LLC <br />Address: 2625 S. Michigan <br />City/State/Zip: South Bend, IN 46614 <br />Phone:(574) 233-8205 Email: <br />ENCROACHMENT INFORMATION: <br />Location of Encroachment: 2625 S. Michigan <br />Encroachment Description: <br />Sign located in R/W <br />CL Road to R/W Line: 100 ft. <br />Distance of R/W: 20 ft. <br />INSTALLER'S INFORMATION: <br />Business Name: US Signcrafters, Inc. <br />Address: 216 Lincolnway East <br />Size of Encroachment:76" inches <br />Amount in R/W. 76" inches <br />City/State/Zip: Osceola, IN 46561 <br />Phone:574.674.5055 Email: dmerritt@ussigncrafters.com <br />Signature: <br />Printed Name: Doug Merritt <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: J <br />R Photos of the area where encroachment will take place. <br />9 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 safefic reon and maybe revoked at anytime. <br />Signature of Applicant: / Date: 5/28/2024 <br />Printed Name of Applicant: ug erritt'► i <br />MAY 3 p 2N4 <br />Div. <br />}tr y ot bou���!,ueno <br />