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APPLICATION NUMBER <br />FEE AMOUNT <br />ESCROW AMOUNT <br />DATE PAID <br />DATE RECEIVED BY CI~ <br /> <br />CITY OF RAMSEY <br /> <br />LAND USE APPLICATION <br /> <br />MINOR MINING and <br />SUBDIVISION REZONING RECLAMATION <br /> <br />SUBDIVISION <br /> <br />PLANNED UNIT DEVELOPMENT <br /> <br />VARIANCE <br /> <br />GRADING OR FILLING <br /> <br />SITE PLAN <br /> <br />CONDITIONAL USE (.~,¢~/'~'~J'~ <br /> <br />Name of Applicant: /~lAt~,DO,~ <br /> <br />Address: 1~7.~1 Dolomite <br />City~tate~ip Code: ~ I~ ~ <br /> <br />Prope~ Ident~ication number: <br /> <br />Fee ~tle Owner: ~NO~- Rl~ms~,, <br /> <br />Subdivision Name: <br /> <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 all terms of the City ordinances which govern. I understand that <br />any changes trom these plans must be resubmitted. <br /> <br />Owne r/Repre sentat~ve (pnnted/typed) Date <br /> <br />Owner/RepCesentative(sig nature) 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 Cff, y of Ramsey and I will <br />be held liable tor any and all costs incurred by the City. . <br /> LD-, <br /> <br />Owner (prinled/typed) Date Owner (sigr~ature) Date <br /> <br />$? <br /> <br /> <br />