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FEE AMOUNT <br />ESCROW AMOUNT / ~",,'9 <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 VARIANCE SITE PLAN <br /> <br />PLANNED UNIT DEVELOPMENT <br /> <br />GRADING OR FILLING ~. CONDITIONAL USE <br /> <br />Address: <br /> <br />Property Identification number: <br /> <br />Subdivision Name; <br /> <br />........ <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~ccept the conditions of this permit and all terms of the City ordinances which govern. I understand that <br /> <br /> · ' d/type ) Date Owner/Representative(signature) Date <br /> <br />I hereby certify that I am the lee title owner or c_c_c_c_~ntra¢~.~Edeed vendee (circle one)of record for the above <br />mentione~L)oroperly. Failure to prove ownership may void any agreements enter into by the City of Ramsey and I will <br />be h~le f~d all c/~s incurred by the City. <br /> <br />(j~p~mq1~l-~ed'~r/ I Date Owner (signature) Dale <br /> <br /> <br />