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CITY <br />LAND <br /> <br />APPLICATION NUMBER <br />FEE A~OUtCT .--~.C~ <br />ESCROW A~O~ ~ <br />DA~ P~D ~ <br />DA~ ~I~D BY ~Y <br /> <br />PLA'UI'ING · ~ <br /> <br />Minor Suixiivision <br /> <br />Subdivision: <br /> <br />Administrafl~ve <br /> <br />Registered kand:, Survey <br /> <br />RF..ZONING <br /> <br />VARANCE <br /> <br />EASEMENT VACATION <br /> <br />SITE PLAN <br /> <br />CONDITIONAL USE <br /> <br />Na,nc of Applicant: ~.~?t <br /> <br /> [ '.'_ <br /> <br />property 0enun=uo n m r: OI - <br /> <br />] undemmnd appBcafipn f~ for a ~d um appli~fion, ff approv~ or de~, is a non-re~n~ble f~. i underfed ~at ~y changes <br />from ~ p~s mu~[ ~r~Submia~ <br /> <br />I hereby certify ttmt I ~arn the fee title owner or contract for deed vendee (circle one)of record for the above mentioned property <br />Failure to prove own~,r.qhlp ma)' vmd an), agreements enter ~nto by the C~5' of Ramsey and 1 will be held li~bie for an>' and all <br /> <br />O~'ner (prmted/b~:~,d) Date O~mer (signatm~) Dam <br /> <br /> <br />