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APPLICATION NUMBER <br /> <br />FEE AMOUNT ..~/" o <br />ESCROW AMOUNT .~ I <br />DATE PAID ~,_..~. <br />DATE RECEIVED BY CITY <br /> <br />CITY OF RAMSEY <br /> <br />LAND USE APPLICATION <br /> <br />MINOR MINING and <br />SUBDIVISION REZONING RECLAMATION <br /> <br />SUBDIVISION <br /> <br />PLANNED UNIT DEVELOPMENT <br /> <br />VARIANCE <br /> <br />GRADING OR FILLING <br /> <br />SITE PLAN <br /> <br />CONDITIONAL USE <br /> <br />Contact Person: ~/'/~ ~. 4~ ~ ~ <br /> <br />Cily/State~ip Code: .~ ~'~ <br /> <br />Property Identification number: <br /> <br />Subdivision Name: <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 />Dale <br /> <br />I hereby certify 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 agreements enter into by the City of Ramsey and I will <br />be held liable for any and all costs incurred by the City. <br /> <br />Owner (printed/typed) Date Owner (signatu~'e) Date <br /> <br /> <br />