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APPLICATION (RECEIPT) NUMBER <br />FEE AMOUNT <br />ESCROW AMOUNT t <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 RF__ZONING RECLAMATION <br /> <br />SUBDIVISION VARIANCE SITE PLAN <br /> <br />PLANNED UNIT DEVELOPMENT <br /> <br />GRADING OR FILLING .,~ <br /> <br />CONDITIONAL USE <br /> <br />Name of Applicant: ,//~.~P.P[CC~X /~. rJ/O , % J,~'_~. Phone# <br /> <br /> cod.: <br /> <br />Prope~y Ident~ication number: <br /> <br />Fee Title Owner: <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 perm~ and all terms o! the City ordinances which govern. I understsnd that <br />any chan~es from these plans must be resubmitted. ' . - <br /> <br />Owne rFRepre sentc, tive (printed/typed) Date Owner/Representative(signature) Date <br /> <br />I hereby certify that I am the tee 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 inlo by the City of Ramsey and ] will <br />be held liable for any and~all ~j~sts incurred by the City. '" ,, ,---'---- <br /> <br />6v~' '-(l~rinted~yped) Dam O~er (signature) ""~ ' Date <br /> <br /> <br />