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APPLICATION (RECEIPT)NUMBER <br />FEE AMOUNT I C'Y-.~.. <br />ESCROW AMOUNT ,, ! ~-~. <br />DATE PAID ~- ~ <br />DATE RECEIVED BY CITY <br /> <br />CITY OF RAMSEY <br /> <br />LAND USE APPLICATION <br /> <br />MINOR \/ MINING and <br />SUBDIVISION ~. REZONING 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 <br /> <br />Name of Applicant: (~.~. ~: C'(), I['J [T~ ~ (.t ~'. t-- Phone <br /> <br />Contact Person: <-~',,"Lf~'~ '~. <br />Address: i <br /> <br />Pro,ny Identification number:_ <br /> <br />Description: <br /> <br />I understand the tee for a variance, conditional use permit and rezoning ~ approved or denied, is a non-refundable <br />fee. I also accept the conditions of this permil and all terms of the Cib' ordinances which govern. ] understand that <br />any changes from these plans must be resubmitted. <br /> <br />OwnerFRepresentative(printed~typed) Date <br /> <br />Owner/Representative(signature) <br /> <br />Date <br /> <br />I hereby certify that I am the fee tide owner or contract for deed vendee (circle one)of record for the above <br />mentioned property. Failure to prove ~wnersh? may void any agreements.e~er into by the City of Ramsey and I will <br />be held liable for any and allcost, incurred b, the Oity.L/~--- F'~'L'dJ ..---.j. _~_).,d' ,' ( ~ ,'" ,[-~-'~ ~?~/ ~-//~~~.~~~ :, <br />Owner (printed/typed) Date ~:)wner (,igna,ure)''''/' - Da,~- ~ <br /> <br /> <br />