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/�- da-4-Le <br />Applicant Signature <br />Please provide a detailed description of your request <br />and attach a copy of your property Iayout (if applicable) <br />/fl ✓ire Prl /1,),/ ,J. f,J t 70% <br />�.t rN J € V <br />lei. / er fA A,%,"t7 0 b, <br />71,1 €/ ice, i .. f c ioek-fo -‘u rk' dfy/G - 74) frva AorH�S <br />4// rel.() - s /-y/e fdu�rrkera4e-S <br />11." <br />A "Land Use Sign" will be placed on tilt u 'ect roperty to <br />ie <br />opportunity to obtain mation about <br />and PrOv,:sie /r <br />amsey Residents the <br />uest. <br />I understand that the application fee is non-refundable. All os sociated with the processing of this <br />application are the responsibility of the applicant whether this applica ' n is approved or denied. Any excess of <br />escrow account deposits over expenditures will be refunded at the e of account closure. I also understand <br />that as the applicant, it is my responsibility to obtain all other permits or licenses required by any applicable <br />regulatory agencies for this Land Use Application V <br />Oda <br />Co -Applicant 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 />Alazai <br />iroperty Owner Signature <br />OG -vy-d 7 <br />Date <br />Co -Property Owner Signature <br />oali -fij d out_diy tfie Cit o Ramse; <br />ppleation amaun <br />Escrow=Amount: <br />Cash .R'eceipt <br />Date Reeei;ved: <br />Escrow Number: <br />Date <br />2 of2 • <br />Updated: January 2004 <br />