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sm2 - o Dane County Zoning office use only <br /> Non-Metallic Mining Reclamation Permit#: APS 12- a <br /> Permit Application Date: S <br /> Landowner: Joel Hougan Agent: Forever Sandfill and Limestone, Inc. <br /> Address: 2371 County Highway BN Address:c/o Jon Halverson <br /> Stoughton, WI 53589 170 Highway 51N, Edgerton, WI 53534 <br /> Phone: 608-873-5824 Phone: 608-884-9105 <br /> E-mail: E-mail: ihalver(a�frontier.com <br /> Address of site: E1/2 of SW 1/4, Sec.09, TO6N, R11 E, Pleasant Springs t20 Acres on NW corner of Koshkonong Road <br /> (may need to be assigned) and South Park Street) <br /> Township: Pleasant Springs <br /> Parcel#: 0611-094-9000-5 Parcel#: <br /> Parcel#: Parcel#: <br /> Parcel#: Parcel#: <br /> Parcel#: Parcel#: <br /> Type of aggregate: Sand/Gravel Total site acreage: 20 Acres(Note: 10 Acres Total Active Mine) <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: es or No Conditional use permit#: <br /> Effective Date: <br /> Expiration Date: <br /> Erosion control/Stormwater permit#: Expiration Date: <br /> 1 hereby request on behalf of the applicant a non-metallic mining permit. I certify,as adult'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 es:dilate this application and ensure compliance with a permit. Also,financial assurance <br /> standards as established"n Ch.74141 od Dane County Code of Ordinances. <br /> Applicant signature: / a, ��°�'4 Date: � '✓ <br /> If the person apply (submitting the application in-person,at the counter)is not the landowner,a notarized statement <br /> authorizing the app cant to act as the landowner's agent must be attached. <br /> Permit received by: N r ej .soo-1� ,A ZO Date: S f �'v 1 1 14 <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 />