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Name: <br />Street Address: <br />City, State, ZIP: <br />Horne Phone: <br />Email: <br />Property Owner infortnaition <br />Of different than ApOrontj <br />O * .- I polorzeti LLC <br />ISO wolritt.Pure- . <br />vnln Tit- , MO 55.30 <br />Work Phone: <br />+x watt 1 5610erwri 4z%' , 6 wri. Fax Number: <br />4�a-85d-g <br />Please provide a detailed description of your request and attached a copy of a scaled site plan <br />pl i s i . _ rir r- & = (A '' 14itY1 <br />A "Land Use Sign" will be placed on the Subject Property to allow Ramsey Residents the <br />opportunity to obtain information about your request. <br />Applicant Signature <br />Printed Name <br />Title <br />Date <br />I 'lit 1, h et I . f k G <br />1)3 <br />Co -Applicant Signature <br />Printed Name <br />Title <br />Date <br />I understand that the application fee is non-refundable. All casts associated with the processing of this application are the <br />responsibility of the applicant whether this application Is approved or denied. Any excess of escrow account deposits over <br />expenditures will be refunded et the time of account closure. I also understand that as the applicant, It is my responsibility to obtain <br />all other permits or licenses required by any applicable regulatory agencies for this Land Use Application. <br />Property Owner <br />Signature <br />Printed Name <br />Title <br />Date <br />Property Owner <br />Signature <br />Printed Name <br />Title <br />Date <br />hereby certify that lam the fee title owner/contract for deed vendee of record for the above -mentioned property. Failure to prove <br />ownership may void any agreements entered into the City and I will be held liable for any and all casts incurred by the City. <br />City of Ramsey General Land Use Application Guide Version 1/1/2013 <br />