Laserfiche WebLink
Name: <br />Street Address: <br />City, State, ZIP: <br />Home Phone: <br />Email: <br />Property Owner Information <br />(If different than Applicant) <br />If N1 <br />Work Phone: <br />Fax Number: <br />Please provide a detailed description of your request and attached a copy of a scaled site plan <br />3//vial/ Ln ! �J��� X /�o©v Stp Cep /fix' �5 eitr-Yl/.t.4 <br />4 ,L-c -f - _2 c2 �-r fV r? S . T 1 ` s / cc f4 /ed N C' V -f--Gr ev <br />6,e,_5, ii1.9ss /A ,%i /--t p at/e)02— We? JJ L (*'e' 'iso <br />e /c) F.J)/o/ { a- 2cit /i, <br />/r-tJf'I I <br />S e 4the pe./1 <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 />Printed Name <br />Title <br />Date <br />Co -Applicant Signature <br />Printed Name <br />Title <br />69`-/S Date, <br />I understand that the application -fee is non-refundable. 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 by any applicable regulatory agencies for this Land Use Application. <br />Property Owner <br />Signature <br />Printed Name <br />Title <br />Date <br />I hereby certify that I am <br />ownership may void any <br />lc e or / <br />iggda1-11,0, <br />Property Owner <br />Signature <br />Printed Name <br />Title <br />Date <br />02,'t <br />'Tose4i ni/Lke /4/e'<.. <br />U"+`4�211L�h <br />9 a3-/3 <br />the fee title owner/contract for deed vendee of record for the above -mentioned property. Failure to prove <br />agreements entered into the City and 1 will be held liable for any and all costs incurred by the City. <br />