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i <br /> iILl'oiUii jV.1G, Fay. Jo8L6./ LLreu,'irwii yr dri.u�..rw <br /> �. Form 3503-28- <br /> f <br /> PLEASE SUBIVIT 2 CGi ;,;; COTIZIS Or TIFF APP:,iCA:I-N T^j ..... APPROPRIATE DN? DTSTPICT <br /> OFFICE. The enclosed map indicates D:-R distric,, boundaries and district office <br /> 4 locations. Assistance in completing applications is available at the district <br /> offices. Map and plans must be submitted with app�ication. If the craw ::gs wall <br /> not fit on 8 x 13" sheets of paper, submit a tracing suitable for blueprinting <br /> p or 12 copies of each. <br /> Owner: ���Vi 1 In a(- Tnc <br /> Address: 110 Main Street, Reedsburg, Wisconsin 53959 <br /> Zip Code <br /> Name of Waterway Culbertson Springs Creek County Burnett <br /> Location of Structure:G.L.3 WW�tRx lboDcxxxxx eux of section 3 township <br /> _40__ north, range 15 (west), Town of Jackson <br /> r <br /> � Legal description of property abutting waterway (from deed): <br /> O L 3 and O L 4 Deerpath Addition to Voyager Village <br /> F <br /> Nature of Ownership: Deed X Land Contract Lease <br /> Other <br /> Type of Structure: road culvert with sand fill <br /> Description (dimensions and materials): corragated metal arch pipe with <br /> • 12' - 6" span 7' - 11" rise with sand fill <br /> Purpose: build public road <br /> Reason structure must be located in waterway: to get vehicles across creek <br /> Building Permits: Have permits been obtained from the following, where required? i6 <br /> Corps of Engineers No County No Local Municipality No <br /> Name and address of persons who own the property abutting the waterway on each side <br /> of applicant's property: <br /> State of Wisconsin <br /> N. <br /> Burnett County F.C.L. , Grantsburg, lsconsln <br /> Voyager Village Property Owners' Assn. , Inc. , Danbury, Wisconsin <br /> Name and address of secretary of property owner's association on waterway (if one <br /> exists). <br /> Voyager Village Property Owners' Assn. , Inc. , Danbury, Wisconsin <br /> Financial Responsibility: Is the owner financially capable of constructing, main- <br /> 3 twining, and removing the structure, if necessary? Yes <br /> Can you submit proof of fins cial status, if required? Yes <br /> Applicant's Signature �'t� � Date /I 0973 <br /> Rev. 9-72 <br /> w g <br />