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Property Owner Information <br />(If different than Applicant) <br />Name: AVnb C, Co d <br />Street Address: 144o U\,_snk Lci:i<Q_glvc1. <br />City, State, ZIP: AnC\O\K_r , M N SS304- <br />Home Phone: 1 Work Phone: <br />Email: <br />`'�Y� SOWN-,� CO:, 4 Fax Number: <br />�1 rr)Y1Vt� , <br />Please provide a detailed description of your request and attached a copy of a scaled site plan <br />,,--P c \.,w ---\- A -Co 1 YA--,-rn ki\ vyy _vo045 (M\n)) aO scAay- phuk-c 1 rc c. <br />c) o,vw. S ` Ky lA � l W L k'1 - -Q V l� 'P Y'ie>(y-2 ) c C1NrcAl . <br />1 c1in5 bc -P\I &rv) -Q 9),(op) Skc>.(ry SuAn,-ec4 , ctnc\ CIRz;Iv\ <br />c l IN A-4 ,11 N. <br />A "Land Use Sign" will be placed on the Subject Property to allow Ramsey Residents the <br />pofnity to obtain information about your request. <br />Applicant Signature <br />Printed Name <br />Title <br />Date <br />vR, Pam[ supply <br />gus 1 k_s,S a)1, wun- - <br />I understand that the application fed -is non!refu able. All costs associated with the processing of this application 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 b -a'fiyy ppli Ile regulatory agencies for this Land Use Application. <br />Property Owner <br />Signature <br />Printed Name <br />Title <br />Date <br />Je(i U) Sorg <br />. CnAk) Advnivi\s4y-oav <br />- -i7 <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 />Co -Applicant Signature <br />Printed Name <br />Title <br />Date <br />Property Owner <br />Signature <br />"7(.,3-323--5(09 3 <br />Printed Name <br />Title <br />Date <br />