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Property Owner Information <br />(If different than Applicant) <br />Name: <br />Street Address: <br />City, State, ZIP: <br />Home Phone: <br />Work Phone: <br />Email: <br />Fax Number: <br />Please provide a detailed description of your request and attached a copy of a scaled site plan <br />: <br />, `a <br />. <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 Signature7 <br />/ <br />Co Applicant Signature <br />Printed Name <br />j <br />i` <br />L <br />t c tz <br />Printed Name <br />Title <br />Title <br />Date <br />Date <br />I understand that the application fee is non-refundable. All costs 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 at 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 />Property Owner <br />Signature <br />Printed Name <br />A( cut; <br />Printed Name <br />lel yxi,y <br />Title <br />Title <br />Date <br />Date <br />I hereby certify that I am 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 costs incurred by the City. <br />City of Ramsey General Land Use Application Guide Version 1/1/2013 <br />