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Property Owner Information <br />(If different than Applicant) <br />Name: <br />/ 6o L <br />Street Address: <br />.75a .3 3 ! UN WOO b DO/ 5 u al ,r 5 S <br />City, State, ZIP: <br />p� G ni,v / 55-3c3 <br />1—� ti <br />Home Phone: <br />/ <br />Work Phone: <br />-no 3 427 �95 <br />Email: , <br />�• <br />Fax Number: <br />i(0? 4 Z741 5 I <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 />Signature <br />- --- ---Co-Applicant <br />Printed Name <br />y' <br />Printed Name <br />Title <br />o <br />Title <br />Date <br />te2/7 // q <br />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 />Property Owner <br />Signature <br />Printed NameMAO <br />® , <br />Printed Name <br />Title <br />%j 00 <br />Title <br />Date <br />/ n //' <br />Date <br />1 hereby certify that I am the fe'e 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 />