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Name: <br />Street Address: <br />City, State, ZIP: <br />Home Phone: <br />Email: <br />Property Owner Information <br />(If different than Applicant) <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 r Ailo X o©v Stp Cep /fix �5 eit(-Yl/.t.4 <br />4 ,L-c -f - _2 c2 fV r? S . T 1 ` s / cc f4 /L>dg N C' V f Gr P�- <br />ss %Ccc.es / , /-gip ai/e)c „ Wc2u%(� 1. (c e ' e� <br />etwn, e /c) F.J)/0/ 1/a- 20 it //, <br />1,/& e.,2 <br />S/riff-J � I <br />S e 4 the I peA <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 />Tc'se..Ph 0 ra. L t.GI J., <br />69--4 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 />d e or) <br />iggda1-11,0, <br />Property Owner <br />Signature <br />Printed Name <br />Title <br />Date <br />02,'t <br />'To-see/1 / 1tLke i4tei< <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 />