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t <br /> Dane County Zoning office use only <br /> 1 Non-Metallic Mining Reclamation Permit#: <br /> Permit Application Date: <br /> I <br /> Landowner: Hepta S, Inc. Agent: Stanley Lien <br /> Address: 372 Koshkonong Road Address: 372 Koshkonong Road <br /> Cambridge, WI 53523 Cambridge, WI 53523 <br /> Phone: (608)423-4014 Phone: (608)423-4014 <br /> rE-mail: E-mail: <br /> IAddress of site: 450 Koshkonong Road,Cambridge,Wisconsin 53523 <br /> (may need to be assigned) <br /> Township: Christiana <br /> Parcel#: 0612-144-90002 Parcel#: <br /> Parcel#: 0612-144-85009 Parcel#: <br /> 1 Parcel#: 0612-143-8240-0 Parcel#: <br /> Parcel#: 0612-143-9500-8 Parcel#: <br /> IType of aggregate: Limestone Total site acreage: Approximately 120 acres <br /> Plan review fees: <br /> (Less than one acre:NO FEE, 1 to 25 acres:$875.00,25 to 50 acres:$1,100.00,More than 50 acres:$1,300.00) <br /> Non-conforming: Yes or No Conditional use permit#: 2159 <br /> Effective Date: <br /> Expiration Date: <br /> Erosion control/Stormwater permit#: 0046515, ES20040262 Expiration Date: <br /> I hereby request on behalf of the applicant a non-metallic mining permit. I certify,as aduly authorized representative or agent that the <br /> operator listed above will comply with the statewide non-metallic mining reclamation standards established in ss.NR 135.05 through <br /> NR 135.15,Wis.Adm.Code. The applicant agrees to provide to Dane County an annual fee as established by county ordinance and <br /> site access for county officials necessary to evaluate this application and ensure compliance with a permit. Also,financial assurance <br /> standards as establishe I in Ch.74141 od Dane County Code of Ordinances. <br /> Applicant signature: / ' S A 1'(.4 . 0° Date: -.J --1�o <br /> If the person applying(submitting the application in-pe ,at the counter)is not the landowner,a notarized statement <br /> authorizing the applicant to act as the landowner's agent must be attached. <br /> 3 <br /> Permit received by: Date: <br /> Permit reviewed by: Date: <br /> This application must be submitted in person M - F, 8 A.M. -4 P.M., <br /> with two copies of all permit materials to: <br /> Dane County Zoning, 210 Martin Luther King Jr. Blvd. Room 116, Madison,WI <br />