Town of Bargersville Application Kit Encroachment Request

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Twn f Bargersville Applicatin Kit Encrachment Request APPLICATION A cmplete applicatin and all required attachments and frms are t be submitted by the date shwn n the Strm Water Bard Meeting Schedule. At that time, staff will review the applicatin t determine whether the applicatin is cmplete. If the applicatin is nt cmplete, it will be returned t the applicant with the identified deficiencies. Applicatins submitted r cmpleted after the psted deadline date will be placed n the applicatin cycle fr the next regular meeting. The fllwing items are required: Cmpleted Applicatin Frm. Yu must include the nature f the issue, wh will represent the issue at the meeting and cntact infrmatin. Letter frm Hmewner s Assciatin. Yu must btain a letter frm yur Hmewner s Assciatin, if applicable, stating their psitin in regards t the encrachment. Fees. Applicatin fee fr the encrachment review is $50.00. Please make check payable t the Twn f Bargersville. An additinal fee f $200.00 will be required if an Encrachment Agreement upn a Utility and Drainage Easement is required (recrded dcument). See belw. Letters frm all Utility Cmpanies. Yu must btain letters (n the apprpriate letterhead) frm all utility cmpanies that service the lcatin f the encrachment, stating their psitin in regards t the encrachment. Please find enclsed a listing f utility cmpanies that service the Bargersville area. This list may r may nt include all f the utilities in yur area. Letter frm Bargersville Water and Sanitatin Departments. Please nte that the Bargersville Water Department and Bargersville Sanitatin Department are n the list f utility cmpanies attached. Even thugh yu are making yur applicatin t the Bargersville Strm Water Utility Bard, a letter frm each department, stating their psitin in regards t the encrachment, must be submitted. Drawing. An accurate and scaled drawing, shwing hw the area will be encrached. Encrachment Agreement upn a Utility and Drainage Easement. Required fr thse requests that include a permanent fundatin. An additinal fee f $200.00 will be required if an Encrachment Agreement upn a Utility and Drainage Easement is required (recrded dcument). Please make check payable t the Twn f Bargersville. Submittal. The applicatin frm, the riginal signed letter frm yur Hmewner s Assciatin (if applicable), payment fr fee, all letters frm the utility cmpanies, including Bargersville Water and Sanitatin Departments, an accurate scaled drawing and a cpy f recrded deed(s) (if applicable) must be submitted t Glenda Jhnstn in the Utilities Administratr s ffice. Glenda Jhnstn, Utilities Administrative Assistant Twn f Bargersville 24 N Main Street Bargersville, Indiana 46106 317-422-3120 ffice 317-422-3743 fax E-mail: gjhnstn@twnfbargersville.rg Website: www.twnfbargersville.rg PLEASE NOTE: The Utilities Administratr will recmmend against apprval f the installatin f any permanent structure which encraches in any utility easement. Hwever, the final decisin is up t the Strm Water Utility Bard and/r Twn Cuncil.

UTILITY COMPANIES INFORMATION Utility Letters Yu must btain a signed letter, n letterhead, frm each utility that serves the lcatin f the encrachment, stating their psitin n the prpsed prject. The fllwing list may r may nt include all f the utilities that serves the lcatin f the encrachment. It is the applicant s respnsibility t btain letters frm ALL servicing cmpanies, regardless f whether they are n the list r nt. Cmpany Cntact Persn Address Phne, Fax, Website, E-mail CABLE TV Cmcast Cable Cmmunicatins, Inc. Metrnet ELECTRIC Twn f Bargersville Duke Energy Indiana, Inc. Indianaplis Pwer & Light Jhnsn Cunty REMC Hsier Energy Rural Electric Cperative, Inc. GAS Steve McArtr Dug Reckart Glenda Jhnstn Jseph Neuenschwander Jhn Hendricks, Engineer Tm Gallagher, Real Estate Specialist 1600 W Vernal Pike Blmingtn, IN 47404-2867 3701 Cmmunicatins Way Evansville, IN 47715 P.O. Bx 420 Bargersville, IN 46106-0420 2515 N Mrtn Street Franklin, IN 46131 One Mnument Circle Indianaplis, IN 46204 750 Internatinal Drive Franklin, IN 46131 211 State Hwy 43 Spencer, IN 47460 (812) 822-3267 phne steve_mcartr@cable.cmast.cm (317) 599-1191 phne (317)599-1141 fax dug.reckart@metrnetinc.cm (317) 422-3120 phne (317) 422-3743 fax gjhnstn@twnfbargersville.rg (317) 736-2014 phne jseph.neuenschwander@ duke-energy.cm www.iplpwer.cm (317) 736-6174 phne (317) 736-8185 fax www.jcremc.cm (812) 876-0377 phne tgallagher@hepn.cm Vectren Energy Perry Clyd 4324 Middle Rad Clumbus, IN 467203-1829 (812) 330-4010 phne pclyd@vectren.cm SANITARY SEWER Twn f Bargersville TELEPHONE & INTERNET AT&T-Indiana Century Link WATER Indiana American Water Twn f Bargersville PIPELINE BP (Nrth America, Inc) Glenda Jhnstn Jshua Hewitt David Meyers Rachel Merrifield Glenda Jhnstn P.O. Bx 420 Bargersville, IN 46106-0420 240 N Meridian Street Indianaplis, IN 46204 50 N Jacksn Street Franklin, IN 46131 2501 Endress Place Greenwd, IN 46143 P.O. Bx 420 Bargersville, IN 46106-0420 BP Pipelines (Nrth America) Land & Right f Way Dept 150 W Warrenville Rad Naperville, IL 60536-9922 (317) 422-3120 phne (317) 422-3743 fax gjhnstn@twnfbargersville.rg (317) 252-5072 phne (317) 252-4013 fax Jh6813@att.cm (317) 736-4863 phne david.meyers@centurylink.cm (317) 881-0270 ext #1 (317) 887-3054 fax www.amwater.cm (317) 422-3120 phne (317) 422-3743 fax gjhnstn@twnfbargersville.rg (630) 536-2519 phne BPPipelinesROW@bp.cm

Twn f Bargersville Bargersville Strm Water Utility Bard ENCROACHMENT REQUEST Submittal Date Hearing Date Fr Office Use Only 1. Applicant Inf Name Street Address City, State, Zip Phne Cell Phne Fax E-mail 2. Meeting Date Yu Wish t Attend Date 3. Persn(s) Wh Will Attend Meeting Name(s) If different frm abve, please cmplete the fllwing: Street Address City, State, Zip Phne Cell Phne Fax E-Mail 4. Nature f the Encrachment Please describe the encrachment request, including what yu are prpsing t place in the easement, what kind f easement yu will be encraching n and the lcatin f the encrachment. 5. Signature The abve infrmatin and attached exhibits, t my knwledge and belief, are true and crrect. Signature f Applicant Date

2018 Twn f Bargersville Strm Water Utility Bard 24 N Main Street Bardrm Applicatin Submittal Deadline Meeting Date Meeting Time January 10 January 22 5:00 PM February 14 February 26 5:00 PM March 14 March 26 5:00 PM April 11 April 23 5:00 PM May 9 May 21 5:00 PM June 14 June 25 5:00 PM July 11 July 23 5:00 PM August 15 August 27 5:00 PM September 12 September 24 5:00 PM Octber 10 Octber 22 5:00 PM Nvember 14 Nvember 26 5:00 PM December 5 December 17 5:00 PM

ENCROACHMENT AGREEMENT UPON A UTILITY & DRAINAGE EASEMENT This cvenant and agreement is made this day f, 20, by ( OWNER ) as wner f, recrded, in, as Instrument Number, in the Office f the Recrder f Jhnsn Cunty, Indiana (hereinafter REAL ESTATE ). T induce the Bargersville Strm Water Utility Bard ( SWUB ) t cnsent t the encrachment upn the water, sanitary sewer, drainage and utility easement (the easement ) granted t the Twn f Bargersville, in the, as recrded in Instrument Number, in the ffice f the Recrder f Jhnsn Cunty, Indiana, which said plat declares a water, sanitary sewer, drainage and utility easement (apprximately in width) ( Easement ), and which cntains public utilities and sanitary sewer structures, sme f which are in the area f encrachment, fr the placement, cnstructin, installatin, and maintenance f the OWNER S sign structure in the Easement as shwn n the diagram and dimensinal rendering attached heret as Exhibit A, with as shwn n Exhibit B, bth f which are incrprated herein by reference, OWNER hereby cvenants, n behalf f itself as wner, and the successrs and assigns t the REAL ESTATE, that the fllwing shall be cnditins and cvenants upn the REAL ESTATE: 1. OWNER shall cnstruct and lcate the at the furthest pint frm the public utility and sanitary sewer facilities as is practically pssible, and in cmpliance with the diagrams and dimensinal renderings shwn n Exhibit A and Exhibit B, attached heret and incrprated herein. 2. OWNER acknwledges that excavatin, cnstructin, installatin, repair, replacement and maintenance f the and the presence f the in the easement culd result in damage t the varius UTILITIES facilities and the sanitary sewer facilities currently lcated, and any future facilities and sanitary sewer facilities which may be lcated, in the easement. OWNER cvenants and agrees t be liable fr any and all damage t the utility facilities and sanitary sewer facilities currently lcated, and any future utility facilities and sanitary sewer facilities which may be lcated, in the easement and agrees t bear the csts f any and all repairs assciated with any damage arising ut f r in any way cnnected with the installed in the easement under the terms hereunder. OWNER further agrees that it shall indemnify and hld the SWUB harmless against all

claims, demands, actins, causes f actin, lsses and expenses f every nature and kind (including attrney s fees) at any time asserted against the SWUB, fr r n accunt f any persn(s) r entities arising ut f r in any way cnnected with the SWUB allwing the encrachment f the in the easement, r arising ut f r in any way cnnected with the excavatin, installatin, cnstructin, repair, replacement, maintenance r presence f the in the easement. 3. OWNER acknwledges that excavatin, cnstructin, installatin, repair, replacement r maintenance f utility facilities and sanitary sewer facilities in the easement culd result in damage t the and accepts the risk f lss fr all damages t the which results frm the excavatin, cnstructin, installatin, repair, replacement, maintenance r use f any utility facilities and sanitary sewer facilities in the easement. OWNER shall hld the SWUB harmless frm, and waives any claim against the SWUB fr lss by OWNER fr damage t the resulting frm required excavatin, installatin, cnstructin, repair, replacement, maintenance r use f the afresaid utility facilities and sanitary sewer facilities, ntwithstanding easement language t the cntrary. OWNER shall nt be prhibited frm an actin fr negligence against any ther party whm OWNER suffers damage as a result f negligence. 4. OWNER shall maintain the in a gd and wrkmanlike manner. 5. OWNER shall nt change the lcatin f the withut btaining the apprval f the SWUB, nr shall OWNER increase the size f the r the area, within the said easement, withut btaining the apprval f the SWUB. 6. OWNER shall ntify the SWUB f any installatin, cnstructin, excavatin, repair, replacement r maintenance activity regarding the prir t the start f such activity within the easement. 7. OWNER agrees that this cvenant and agreement shall be in recrdable frm and recrded. OWNER shall be respnsible fr all the recrding fees necessitated by r cnnected with this cvenant and agreement. 8. OWNER warrants that it is the sle wner f the REAL ESTATE pursuant t a Special Warranty Deed recrded as Instrument Number in the Office f the Recrder f Jhnsn Cunty, Indiana, and this cvenant and agreement will be recrded in the chain f title f the REAL ESTATE. 9. It is the intent f the parties that this cvenant and agreement and the cvenants cntained herein, shall run with the land, referred t here as the REAL ESTATE, and shall be binding upn the OWNER, its persnal representatives, heirs, devisees, grantees, successrs, and assigns s lng as the said drainage, utility, landscape, water and sanitary sewer easement burdens any f the REAL ESTATE wned by it and the encraches upn said easement. It is further agreed that the failure t specifically describe a cvenant as ne running with the land r as binding upn the OWNER, its successrs and assigns, r the failure t use any language at all indicating such, shall nt be cnstructed t mean that the Agreement s prvisin is nt a cvenant that is t run with the land. If any such prvisin can be cnstructed t tuch and cncern the land itself s that the

benefit r bligatin culd pass with the wnership, then it is the parties intentin that it be s cnstrued. IN WITNESS WHEREOF, the parties heret have set their hands and seals this day f, 20. By By Printed Name Printed Name STATE OF ) ) SS: COUNTY OF ) Befre me, a Ntary Public in and fr said Cunty and State, persnally appeared and wh, after having been duly swrn, acknwledged the executin f the freging Cvenant and Agreement fr and n behalf f such crpratin t be a vluntary act and deed. Witness my hand and Ntarial Seal this day f, 20. My cmmissin Expires: My Cunty f Residence: Ntary Public (Printed) I affirm that I have taken reasnable care t redact each scial security number in this dcument, unless required by law. B.J. Deppe This instrument prepared by B.J. Deppe, Bargersville Twn Attrney, 9 East Curt Street, Franklin, Indiana 46131.