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APPLICATION (RECIEPT) NUMBER <br />FEE AMOUNT / 00. ~'~ <br />ESCROW AMOUNT I ~:~ b- ~ <br />DATE PAID I( I~q~ I ~/ <br />DATE RECEIVED BY CITY 11! <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 <br /> <br />CONDITIONAL USE <br /> <br />Contact Person: <br /> <br />Property Identification number: <br /> <br />Fee Title Owner: <br /> <br />Subdivision Name: <br />Description: <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 accepl the conditions o! this permit and all terms of the City ordinances which govern. I 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 (signaturet, J Date <br /> <br /> <br />