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jUN2 <br />APPLICATION (RECIEPT) NUMBER c='~ <br />FEE AMOUNT- <br />ESCROW AMOUNT., IZ~'-~..(::~,,~ <br />DATE PAID ('~- <br />DATE RECEIVED BY CITY <br /> <br />CITY OF RAMSEY <br /> <br />LAND USE APPLICATION <br /> <br />MINDR MINING and <br />SUBDIVISION . ~X <br /> REZONING <br /> RECLAMC, T ~DN <br />SUBDIVISION VARIANCE SITE PLAN <br /> <br />PLANNED UNIT DEVELOPMENT <br /> <br />GRADING OR FILLING <br /> <br />CONDITIONAL USE <br /> <br />Name of Applicant; <br /> <br />Contact Person: ~ <br /> <br />City/State/Zip Code:. 1~ L/~/rc~ d"~ / ~, <br />Property Identification number: <br /> <br />Fee 'Rile Owner: <br /> <br />Subdivision Name: <br /> <br />I understand the tee ior a variance, conditional use permit and rezoning if approved or denied, is a non-refundable <br />tee. I also accept the conditions of this perm,, and all terms of the City ordinances which govern. 1 understand that <br />any changes trom these ptans must be resubmitted. <br /> <br />Owne r/Representative(printed/~yped) <br /> <br />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/tTped) Date Owner (signature) Date <br /> <br /> <br />