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APPLICATION NUMBFR <br />FEE AMOUNT / O <br />ESCROW AMOUNT. <br />DATE PAID .9- <br />DATE RECEIVED BY <br /> <br />CITY OF RAMSEY <br /> <br />LAND USE APPLICATION <br /> <br /> MINOR MINING and <br />_ .. SUBDIVISION RF_.ZONING RECLAMATION <br /> <br />SUBDIVISION <br /> <br />PLANNED UNIT DEVELOPMENT <br /> <br />VARIANCE <br /> <br />GRADING OR FILLING <br /> <br />SITE PLAN <br /> <br />CONDITIONAL USE L~cc <br /> <br />Nameof cant: Ik~G~O/ff, c ~,~¢~.'¢ ' Phone¢ <br /> <br />Contact Person: ~I~'T ~:~,~LL .CqQi'~qQ~') _ ~¢.t;4~ ~ FNSON' (qg~-;~qq'} <br />Address: / TEI Dolom,'¢e <br /> <br />City/State/Zip Code: '~ 1, m <br /> <br />Property Identification number: <br /> <br />Subdivision Name: "~ <br /> <br />Description: <br /> <br /> 1 understand the fee Jor a variance, conditional use permit, and rezoning if approved or denied, is a non-refundable <br /> ~ee. I also accept the conditions of this perm~ and all terms of the City ordinances which govern. I understand that <br /> any changes from 1hose plans must be resubmitted. <br /> <br />· . LD,~~5~';5 <br />J iOkl - ,,ms v ~m¢,OOn',i!t. iir,-( 5~,~~ q-ii-et q-¢/.¢' <br /> Owner~epre¢en~afive(printed~yped) Da~e Owner/Representative(signet ute) Da3e <br /> <br />I hereby certity 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 into by the Chy of Ramsey and I will <br />be held liable for an), and all costs incurred by the Ch),. <br /> <br />Owner (printed~yped) Date Owner (signature) Date <br /> <br /> <br />