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APPLICATION (RECIEPT) NUMB. E_R <br />FEE AMOUNT ~"- ~~ <br />ESCROW AMOUNT .. ,~', <br />DATE PAID ///// <br />DATE RECEIVED BY CITY /./,/7/7 //' £'? <br /> <br />CITY' OF RAMSE¥ <br /> <br />LAND USE APPLICATION <br /> <br />MINOR MINING and <br />SUBDIVISION ,/~ REZONING ~ RECLAMATION <br /> <br />SUBDIVISION VARIANCE SITE PLAN <br /> <br />PLANNED UN IT DEVELOPMENT <br /> <br />GRADING OR FILLING <br /> <br />CONDITIONAL USE <br /> <br />Name of Ap~licant.'~ ' '"/(' (~ ~'"'."'~"/ Phone # .'~/'"~x' - .?/'3 t::5? <br /> <br />Contact Person:. <br /> <br />Address: <br /> <br />City/State/Zip Code: <br /> <br />Property identification number:. <br /> <br />I understand the fee for a variance, conditional use permit and rezoning if approved or denied, is a non-refundable <br />~'ee, I also accept the conditions of 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) e Owner/Representative(signature) <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 properly. Failure to prove ownership may void any agreem~nCs~er into by the City of Ramsey and I will <br />be held liable tor any and all costs incurred by the City. - .-'"'.-'~.,~.,,/ ...~' - ..~' , <br /> <br />Owner (printed/typed) Date Owner (signature) Date <br /> <br /> <br />