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Name: <br />Street Address: <br />City, State, ZIP: <br />Home Phone: <br />Email: <br />Property Owner Information <br />Of different than Applicant) <br />Work Phone: <br />Fax Number: <br />Please <br />provide a detailed description of your request and attached a copy of a scaled site plan <br />°.gyp eJ uj\DAA,,1 'r. ljt 4 CI � I fA <br />1.-P.veA0fi<LtA- <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 />1�4sue r4, <br />/1" La vLfie <br />l f. J' • <br />Co -Applicant Signature <br />Printed Name <br />Title <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 re ons it ty 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 />A( <br />reet16 <br />Property Owner <br />Signature <br />_1/J11 <br />I hereby certify that 1 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 />Printed Name <br />Title <br />Date <br />