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APPLICATION NUMBER '~- / j ''~ / <br /> <br />FEE AMOUNT <br />ESCROW AMOUNT <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 VARIANCE SITE PLAN <br />PLANNED UNIT DEVELOPMENT GRADING OR FILLING CONDITIONAL USE <br /> <br />City/State/Zip Code: A//-./~,/~-- , <br />Properly Identification number: .~,¢..7~ ¢' <br /> <br />Fee Title Owner: <br /> <br />Description: /~ ~ rX//-7~' J"'~-' . ec~,-,-c-'J --~ --~ <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. ! understand that <br />any changes from these plans must be resubmitted. <br /> <br />Owner/Representative(printed/typed) Date Owner/Representative(signature) Date <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 (signature) ' Date <br /> <br /> <br />