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FEE AMOUNT <br />ESCROW AMOUNT <br />DATE PAID <br />DATE RECEIVED BY CITY <br /> <br />CITY OF RAMSEY <br /> <br />LAND USE APPLICATION <br /> <br />b11N C)R MINING and <br />SUBDIVISION R~._ZONING RECLAMATION <br /> <br />SUBDIVISION <br /> <br />PLANNED UNIT DEVELOPMENT <br /> <br />VARIANSE <br /> <br />Gl:JADING OR FILLING <br /> <br />SITE PLAN <br /> <br />CONDITIONAL USE <br /> <br />Fee '~tle Owner: <br /> <br />Subdivision Name: <br /> <br />Description: <br /> <br /> understand the lee for a variance, conditional use permh and rezoning if., approved or denied, is a non-refundable <br />~ee. I also accep'~ the conditions of this perm~ and al! terms o~, the City ordinances which govern, I understand <br />an), changes from these plans taus', be resubmmed. <br /> <br />Owner/Represemmive(signa[ure) <br /> <br />I hereby certify that I am the fee title owner or contra~ ior deed vendee (circle one)of record ior the above <br />mentioned proper'O,. Failure to prove ownership ma), void an)' agreements enter into by the Oily of Ramsey and I will <br />be held liable ior an), and all costs incurred by the Chy. <br /> <br />Owner (primedtlyped) Date Owner (signature) Dale <br /> <br /> <br />