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APPLICATION NUMBER <br />FEE AMOUNT ./ O th, Et-) <br />ESCROW AMOUNT /---(-'t~ . ~ <br />DATE PaID ,/~> . I --2 - ~ '=/'. .... <br />DATE RECEIVED BY CITY / L--- \-7 ~ ~'~ ~ <br />/ <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 /> <br />PLANNED UNIT DEVELOPMENT <br /> <br />GRADING OR FILLING X CONDITIONAL USE <br /> <br />Name of Applicant: <br /> <br />Contact Person: <br /> <br />Address: <br /> <br />City/State/Zip Code: <br /> <br />Property Identification number: ...~/o ~ ..~..~ ~ 2....,~-- ,_~ ~ --lb ~ ~ ~ <br /> <br />Fee Title Owner: <br /> <br />Subdivision Name: <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. 1 understand that <br />any changes from these plans must be resubmitted. <br /> <br />Owner/Representative(printed,typed) Date <br /> <br />Ow r~e r/R e p~'~'s e nt ~.t~'ve(sig n~ 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 />menticr-~ iroperly. Failure to prove ownership may void any agreements enter into by the City of Ramsey and I will <br />0e held liab!e ior any and ali costs recurred by the City. <br /> <br /> (printed/typed) Date <br />Owner ~wner (signature) ' - <br /> <br /> <br />