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MINOFt <br />SUBDIVISION <br /> <br />SUBDIVISION <br /> <br />PLANNED UNIT DEVELOPMENT <br /> <br />APPLICATION NUMBER <br />FEE AMOUNT ~" ~ <br />ESCROW AMOUNT <br />DATE PAID l- ~-2 <br /> <br /> CITY OF RAMSEY <br /> <br />LAND USE APPLICATION <br /> <br />MINING and <br />RECLAMATION <br /> <br />SITE PLAN <br /> <br />CONDITIONAL USE <br /> <br /> REZONING <br /> <br /> VARIANCE ~' <br /> <br /> GRADING OR FILLING <br /> <br />Name of Applicant: &t~w~ '~ ~--~v'~%c~--, Phone# ~Sq '~~ <br /> <br />Contact Person: ~( <br />Address; ~ ~ ~ ~ ~ ~ ~ <br />City/State~ip Code: ~ ~ ~ ~ ~ ~ ~ ~ ~ <br />Pro~y Identification number: ~ ~ ~ ~ ~'~ ~-~-~ ~'-~ ~ ~ <br />Subdivision Name: ~ ~ ~C~5'~ ~ ~~ <br />Description: ~~ ~ ~ ~ <br /> <br />I understand the fee for a variance, cond~ional use perm~ and rezoning E approved or denied, is a non-refundable <br />fee. I also accept the conditions o~ this ~rm~ and all terms of the City ordinances which govern. I understand that <br /> <br />any changes from these plans must be resubmitted. <br /> <br />.,~/Represe~at ive(sig nat u re) <br /> <br />Owner/Representative(printed/typed) Date <br /> <br />Date <br /> <br />I hereby certify that I am the owner of record for the above mentioned property. Failure to prove ownership may void <br />any agreements enter into by the City of Ramsey and I will be held liable for any and all costs incurred by the City. <br /> <br />Owner (printed/typed) Date O,wn;~ (signature) Date <br /> <br />95" <br /> <br /> <br />