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APPLICATION (RECIEPT) NUMBER <br />FEE AMOUNT )60. ~ <br />ESCROW AMOUNT l~'b- ~ <br />DATE PAID 11 /"L~ I ~ <br />DATE RECEIVED BY CI~ l i/ <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 />City/State/Zip Code:_ ~__ ~) ~ ~J '~ <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 accept the conditions of this permit and al{ 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 Ramsay and I will <br />be held liable for any and all costs incurred by the City., ~'~ ~.~/~~ <br />Owner (printed/typed) Date Owner (signature) } Date <br /> <br /> <br />