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APPLICATION NUMBER <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 <br />SUBDIVISION <br /> <br />SUBDIVISION <br /> <br />gi~- NNED UNIT DEVELOPMENT <br /> <br />RE. ZONING <br /> <br />VARIANCE <br /> <br />GRADING OR FILLING <br /> <br />MINING and <br />RECLAMATION <br /> <br />SITE PLAN <br /> <br />CONDITIONAL USE <br /> <br /> Name of Applican,: <br /> <br /> Contact Person: <br /> <br /> Prope,y Identification number: <br /> <br /> Subdivision ~ame: ~ ' <br /> <br /> Description: <br /> <br /> I understand the fee %r a variance, conditional use perm~ and rezoning ~ approved or denied, is a non-refundable <br /> fee. I a~ccept the conditions of this perm~ and all ~erms of the City ordinances which govern. I understand that <br /> any ~n~ ~r~ese plans~ust be resubmi~ed. <br /> <br />~e r~ep~ se~tative (~n~ted~yped) Date Owner/Represe ntative (signmure) Date <br /> <br />I hereby certity that I am the tee title owner or c.~ntra~deed vendee (circle one)of record for the above <br />mentione~J..~roperty. Failure to prove~wnership may void any agreements enter into by the City of Ramsey and I will <br />be he/l~a'ble ~o/.~d ~11 c¢9¢ts in.urred by the City. <br /> <br />~'~p"~n~e~'/t~ed'~ I Date Owner (signature) Dine <br /> <br /> <br />