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Applicant Name <br />Applicant <br />Address <br />Major Plat Application <br />Final Plat <br />Applicant/Contact Information <br />An /bfm/4- 4 <br />.iD/7/a n , / nC <br />Street address <br />;0f4o X' 1 "Ld j( Lt. <br />Home Phone Number ( <br />Email Address <br />Name of Plat: (required) <br />Tow,' <br />Ce S-et <br />I understand that all costs associated with <br />applicant whether this application is ap <br />expenditures will be refunded at the ti <br />responsibility to obtain all other pe • <br />Use Application. <br />City <br />'' ' /Po ke�.//'c <br />State Zip <br />,SS o <br />9sz-9Fs - `7 <br />Work Phone Number ( ) <br />95,? ygs - 7 *4o <br />Fax Number ( <br />• <br />A� <br />r ssing th of this application are the responsibility of the <br />denied. Any excess of escrow account deposits over <br />count closure. also understand that as the applicant, it is my <br />es requiredy applicable regulatory agencies for this Land <br />Applicant Signature <br />P" PI 404,11/40) <br />Applicant Signature Coo -Applicant Signature Date <br />I hereby certify that I am the fee title ownel�`ct r 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 />Property Owner Signature <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 />o` '1-o7 <br />Date <br />Co -Property Owner Signature <br />Date <br />pplicarona'mnunfi <br />:Esc ow Amo.unt::.7 .1.. _ . _- ; . .- : •-J 7 <br />Da Paid. :"P _�,.�,� <br />CashRece�pt. q - rr . s' . <br />scro*. iim <br />1 of 1 <br />Updated: January 2004 <br />