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Applicant Name <br />Applicant <br />Address <br />Major Plat Application <br />Preliminary Plat <br />Applicant/Contact Information <br />Qon /MaeoiheA, <br />Q•/P• //O,,'a, /oe',- Win rte.ro <br />Street address <br />,2WSGo /('eoie,,i9e C/. # /00 <br />Home Phone Number ( ) <br />Email Address /'4M //on c4 & drk'1 n . epn, <br />Name of Plat (Required): <br />City <br />Work Phone Number ( ) <br />Fax ) <br />All costs associated with the processing of this application are the resp <br />application is approved or denied. Any excess of escrow account de <br />the time of account closure. I also understand that as the applic <br />permits or licenses required by any able regulatory agencie<1 <br />Applicant Signature <br />I hereby certify that I am the fee title owne <br />property. Failure to prove ownership may <br />held liable for any and all costs incurred by <br />Property Owner Signature <br />State <br />m� <br />Zip <br />f the applicant whether this <br />xpenditures will be refunded at <br />y responsibility to obtain all other <br />s Land Use Application. <br />Date "% j-Applicant Signature <br />Date <br />eed'endee of record for the above -mentioned <br />ements entered into by the City of Ramsey and I will be <br />Date <br />Co -Property Owner Signature <br />out bye the C►ty of Ramsey; <br />pIicatinnsaount <br />iserow'Amo.nt: NJA ,Lw,„x..t,. <br />ashReceiet. NIA <br />Date Recei�ed - .. - <br />se ow'.lNTumber <br />Date <br />1 of 1 <br />Updated: January 2004 <br />