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APPLICATION NUMBER <br />FEE AMOUNT <br />ESCROW AMOUNT <br />DATE PAID <br />DATE RECEIVED BY CITY <br /> <br />2-1171 <br /> <br />CITY OF RAMSEY <br /> <br />LAND USE APPLICATION <br /> <br />MINOR <br />SUBDIVISION <br /> <br />RE. ZONING <br /> <br />MINING and <br />RECLAMAT~DN <br /> <br />SUBDIVISION <br /> <br />PLANNED UNIT DEVELOPMENT <br /> <br />VARIANCE <br /> <br />GRADING OR FILLING <br /> <br />SITE PLAN <br /> <br />~ONDITIONAL USE <br /> <br />Property Ident~'ication number:. <br /> <br />Fee Title Owner: <br /> <br />I understand the tee for a variance, conditional use permit and rezcnin~ E approved or denied, is a non-refundable <br />fee. I also a~,.ep', the conditions of this perm~ and all terms of the Ci,ty ordinances which govern. I understand that <br />any changes from these plans must be resubmitted. <br /> <br />Owner/Reptesen,ative (or[nted/'~yped) Date Owner/R~presen~a~ive(si~ nature) Date <br /> <br />I hereby certify that I am the fee title owner or contras for deed vendee (circle one)o,' record for the above <br />mentbned property. Failure tc prove ownership may void any agreements enter intc by the City ef Ramsey and I will <br />be held liable for an)' and ali costs incurred by the City. <br /> <br />Owner (.~rime~'pe~) Da~e Owner (signature) Da;e <br /> <br /> <br />