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Carty off <br />RAMSEY <br />Applicant Name <br />Applicant <br />Address <br />Major Plat Application <br />Final Plat <br />Applicant/Contact Information <br />RoN Mu1-t.GNBAGH <br />D IP• /f opt row, t. - MINN Es oTA Arm <br />Street address <br />City State Zip <br />24,114 D KENBA/A E CT STE /Do LotKEvi44z /i't N Sso #4 <br />Home Phone Number ( ) N/A <br />ttmu//tnkaci, <br />Email Address N oirAorfsq • GerH <br />Name of Plat: (required) <br />Work Phone Number cis'1 d s' 72 7p. <br />Fax 1)fi{l r VA) 9ZS - 49INEV. 7 dy <br />6424..e 5 72%260244CieN <br />I understand that all costs associated with the processing of this application e the responsibility of the <br />applicant whether this application is approved or denied. Any excess of scrow account deposits over <br />expenditures will be refunded at the time of account closure. I also understand that as the applicant, it is my <br />responsibility to obtain all other permits or licenses required by any applicable regulatory agencies for this Land <br />Use Application. <br />(Ns, <br />cmfrd tivm <br />Applicant Signature <br />DatIC\ <br />e NApplicant Signature Date <br />I hereby certify that I am the fee title owner/contract for deed vendee of record for the above -mentioned <br />property. Failure to prove ownership may void any agreements entered into by the City of Ramsey and I will be <br />held liable for any and all costs incurred by the City. <br />SAnoe ,4s 46o v,E. <br />Property Owner Signature Date Co -Property Owner Signature Date <br />In the event the applicant's escrow <br />account shows a negative balance, <br />the applicant must deposit money <br />into the escrow account to provide a <br />positive balance. The City cannot <br />accept the final plat application until <br />the escrow account has a positive <br />balance. <br />1 of 1 <br />Updated: January 2004 <br />To be filled out by the City of Ramsey: <br />Application amount: N/A <br />Escrow Amount: <br />Date Paid: Off_ _( <br />Cash Receipt: <br />Date Received: <br />Escrow Number: r 1 tY 4 <br />-cc (44% <br />