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APPLICATION NUMt~ER <br />FEE AMOUNT ? O ~, ~ <br />ESCROW AMOUNT '/.~"'h . ~'"':~ <br />DATE PAID ?~- 1'-7- ~ <br />DATE RECEIVED ~Y CITY ~ ~- ~-7 ~ ~ ~' <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 />SrTE PLAN <br /> <br />CONDITIONAL USE <br /> <br />Contact Person: <br />Address: <br /> <br />Name of Applicant: ~/S /~/7 c, ,~C~ ~, .c Phone #, _~-.~.7//' ~ ~ ~ ~ <br /> <br /> ~/.77D ~/ /~/ ~,~ ~ ~ <br />Chy~tate~ip Code: .~ /~ / ~ ~, ~,~ ~ / <br />Prope~ Ident~ication number: ~ ' ~ ~ --~-- ~ ~ -- ~ ~ ~ ~ <br /> <br />Fee Title Owner: <br /> <br />Subdivision Name: <br /> <br />I understand the fee for a variance, conditional use permit and rezoning if approved or denied, is a non-refundable <br />tee. I also accept the conditions of this permit and ail terms of the City ordinances which govern. I understand that <br />any changes from tt~ese plans must be resubmitted. <br /> <br />Owner/Representalwe(printedttyped) Date <br /> <br />Own e r/Re pre se ntat.ive (sig na,a,a,a,a,a,a,a,a,a~~' 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 />mention' .'~ ,;roperty. Failure to prove ownership may void any agreements enter into by the City of Ramsey and 1 wit( <br />0e helc liable for any and ali costs incurred by the City. <br /> <br />Owner (printec~/typed) Date ~):wner (signature) <br /> <br /> <br />