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APPLICATION NUMBER ,.,'~0 ~ _.~ <br />FEE AMOUNT ~ _~ o c~, c~-'~, <br />ESCROW AMOUNT ~' <br />DATE PAID /~ !.3-~c~ <br /> <br />CITY OF RAMSEY <br /> <br />LAND USE APPLICATION <br /> <br />MINOR MINING and <br />SUBDIVISION RE. ZONING RECLAMATION <br />SUBDIVISION VARIANCE % SITE PLAN <br /> <br />PLANNED UNIT DEVELOPMENT <br /> <br />GRADING OR FILLING <br /> <br />CONDITIONAL USE <br /> <br />Property Identification number: <br /> <br />................ · ............... , ................. ~ ~--- . <br /> ...... .... L.. P. <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 />a.~ cha. ngc~ from these pla~ must be resubmitted. <br /> <br /> O/wner/F~presentative(printed/ty/ped) Date Owner/Representative(signature) Date <br /> <br /> /_ <br />I hereby_ certify that Yam the ow[~er of record for the above mentioned property. Failure to prove ownership may void <br />any ~en).~nts ~ in~/~y t~e' City of Ramsey and I will be held liable for any and all costs incurred by the City. <br /> <br />OwneF'(pr,~t~/typodi - / Date <br /> <br />/0 <br /> <br /> <br />