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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: Field Point Subdivision <br />Address: 3217 Stone Briar Dr <br />City/State/Zip: South Bend, IN 46628 <br />Phone:574-210-6923 Email: tonyandcarrie@comcast.net <br />ENCROACHMENT INFORMATION: <br />Location of Encroachment: Intersections of Maple Rd & Portage Ave and Laural Creek Dr & Brick Rd <br />Encroachment Description: Replacement of existing signs for Field Point Subdivision <br />Laurel Creek DR & Brick Rd / Maple Rd & Portage Ave 9g" <br />CL Road to R/W Line: Size of Encroachment: <br />Distance of R/W: 15-20' Amount in R/W: 96" <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: �"� fiu—a&�? <br />Printed Name: Dana Baker <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />❑ Photos of the area where encroachment will take place. <br />❑ Plans and Specifications <br />❑ 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 safe flow of traffic thereon and may be revoked at any time. <br />Signature of Applicant: Date: <br />irit�I��licant: Dana Baker <br />�' <br />JUL 11 2024 <br />City Ot South bend <br />Dtv. of Emwieetl9 <br />