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Property Owner Information <br />(tf different than Applicant) <br />Name: <br />a o rri rn ei r- , ad 11 s I- c6 -tiers ` -- e L .ic(c& U U 0 t c: c �,5 -1-0 r (c`] cep) cook <br />Street Address: <br />( 1 C).1..:3 L) iti .S 1-0 c F ; o L p r• -`, c) .- 4,0 ,-k Yl e_v e t'i i . k- e L./JO ,....i [r [ • I le_. `14_7 tt .s e <br />City, State, ZIP: <br />, <br />i <br />5 -.t_. cl L. + Inert 4-c, 0 k- P.- e - t i o/1 ice.�R 4 S�l L1- cel + 1 <br />Home Phone: <br />' w a� ,l_e_ �cr-e 0 1cJk,,r i`.1E .c (--) c c 'S`(o n c--\ 1..) c . a C.cc :i er-`t r- <br />Work Phone: <br />Email: <br />Fax Number: <br />rovide a detailed description of your request and attached a copy of a scaled site plan <br />cc'ugii . ic..�C t.,,a .J..I c1 / k 40 loo. -L 1 c% <br />we ( .t..r r en M-- ha_ V -e 0— -Cocci 7r <br />a o rri rn ei r- , ad 11 s I- c6 -tiers ` -- e L .ic(c& U U 0 t c: c �,5 -1-0 r (c`] cep) cook <br />0—trI d 0 1"Q 0 .4. -t iz p , { J e X O C wt [i [ t +2. `l, -t, k CL 0 e ('.�. r 0 k E r 4.4., cLj c... C7 ,.+..! el <br />( 1 C).1..:3 L) iti .S 1-0 c F ; o L p r• -`, c) .- 4,0 ,-k Yl e_v e t'i i . k- e L./JO ,....i [r [ • I le_. `14_7 tt .s e <br />/ <br />rA..+i -4-- o •P 4 -,Lt n4 -4-0-c .- e r4 Cp tE.-Lyf ' '1-tt,S'e' 10 (A..4 -1O O. .5 LLiQ A et•V -C <br />, <br />i <br />5 -.t_. cl L. + Inert 4-c, 0 k- P.- e - t i o/1 ice.�R 4 S�l L1- cel + 1 <br />ll �r <br />Lr...x 0 wi ci t,m L. i C ^t, el Q-ed ; eL�4 A Cl -1 rt] 4i i ,- i e. c o ✓n .zr e.rt 4,04. crny . <br />' w a� ,l_e_ �cr-e 0 1cJk,,r i`.1E .c (--) c c 'S`(o n c--\ 1..) c . a C.cc :i er-`t r- <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 />Co -Applicant Signature <br />Printed Name <br />Printed Name <br />Title <br />Title <br />Date <br />Date <br />I understand that the application fee is non-refundable. Ail 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 aver <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 />ail 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 />Printed Name <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 />