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i <br /> Property Owner information <br /> (if different than Applicant) <br /> Name; 0,R <br /> " 1 O rl-�L <br /> Street Address: <br /> 4 <br /> City,State, ZIP: ` - . <br /> — ns <br /> Home Phone: Werk Phone: , , ` <br /> �C>--L '�z <br /> Email: 1 c�wc , rE s .tie c.r�` Fax Number: �j f -- 3 <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 Co-Applicant Signature <br /> I <br /> Printed Name �� Printed Name <br /> Title Title <br /> Date `7 Date <br /> I understand that the application fee is non-refundable. All costs associated with the processing of this applicatlon 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 } — Property Owner <br /> Signature �- -----� Signature <br /> Printed Name , ' ylv6 Printed Namep�ccc�4�� Y� <br /> Title Title <br /> Date ,Z_ Date <br /> i <br /> 2 <br /> I hereby certify that I am the fee title owner/cont'ract for deed vendee of record for the above-menti ned 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 />