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Property Owner information <br />(If different than Applicant) <br />Name: <br />, <br />Street Address: <br />Iry -12> <br />Sr +� <br />City, State, ZIP: <br />Home Phone: <br />[i-> <br />Cf- <br />Work Phone: <br />--(,`S'---r-- <br />SV- <br />Email: <br />l wc <br />t' <br />erkrlca c c.r,` <br />Fax Number: <br />Li <br />b.3q— c <br />-t f t,y\y 1f r Cce (Y\' <br />Please provide a detailed description of your request and attached a copy of a scaled site plan <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 />�- <br />Printed Name <br />Printed Name <br />Title <br />6)CO<l�- --- <br />Title <br />Date <br />-2/ 2_// 7 <br />Date <br />1 understand that the application fee is non-refundable. All costs associated with the processing of this annlicatlon are the <br />responsibility of the applicant whether this application is approved or denied. Any excess of escrow account deposits over <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 />all other permits or licenses required by any applicable regulatory agencies for this Land Use Applicati, n. <br />Property Owner <br />Signature <br />Printed Name <br />Title <br />Date <br />Property Owner <br />Signature <br />Printed Name <br />Title <br />Date <br />\ O cc c cko r it„, <br />Ceo <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 />