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APPLICATION NUMBER <br />FEE AMOUNT ID/__~r..~ <br />ESCROW AMOUNT <br />DATE PAID <br />DATE RECEIVED BY CITY <br /> <br />CITY OF RAMSEY <br /> <br />LAND USE APPLICATION <br /> <br />MINOR <br />SUBDIVISION <br /> <br />SUBDIVISION <br /> <br />PLANNED UNIT DEVELOPMENT <br /> <br /> MINING and <br />REZONING RECLAMATION <br /> <br />VARIANCE SITE PLAN <br />GRADING OR FILLING CONDITIONAL USE <br /> <br /> Applicant: -- ~ ~ . 'C' Phone <br />Contact Person: '~ o,~ ,,., ~ ~ ~_ ~. ~ ~ .Y- <br />Address: \"~ '~ ~" t~ ~ ~ ~ ~ ~ %~ V ~ <br /> <br />C~y/State~ip ~de: ~ ~ ~ ~ o ~ <br /> / <br />Pro~ Ident~ication number: 0 ~ - 3 Z - % ~-- <br /> <br />Fee ~tle Owner:~ ~ ~ ~ ~ <br />Su ivis,on..m.: <br />Description: ~ ~ ~ <br /> <br />I understand the fee for a variance, conditional use permit and rezoning if approved or denied, is a non-refundable <br />fee. I also accept the conditions of this permit and all terms of the City ordinances which govern. I understand that <br />any changes from these plans must be resubmitted. <br /> <br />Owner/Representative(printed/typed) Date '" . <br /> <br />Owner/Representative(signature) <br /> <br />Date <br /> <br />I hereby cedify that I am the fee title owner or contract for deed vendee (circle one)of record for the above <br />mentioned property. Failure to prove ownership may void any ~gre~eC/etnts enter ipso ~y the City of Ramsey and I will <br />be held liable for any and all costs incurred by the City. '-'~ ~/ '(~" ¢'" ' ' ~¢'J'~/L"I "~ 'J~"~~' <br />Owner (printed/typed) Date O~nar-(signature) -"Ak-' ~ J{ C~Oate <br /> <br /> <br />