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Property Owner Information <br />(if different than Applicant) <br />Name: <br />Street Address: <br />City, State, ZIP: <br />Home Phone: <br />Work Phone: <br />Email: <br />Fax Number: <br />Please provide a detailed description of your request and attached a copy of a scaled site plan <br />\a <br />r <br />S{ <br />C�\t r 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 />Co -Applicant Signature <br />i <br />Printed Name <br />�a,Cob c���S� <br />Printed Name <br />Title <br />Title <br />Date <br />I yp' 2� <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 />�GOU %�--�-- <br />Property Owner <br />Signature <br />Printed Name <br />l J�I,.L� <br />D Y 1 <br />Printed Name <br />Title <br />Title <br />Le /1.0/2.1 Date <br />Date <br />1 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 />Scanned with CamScanner <br />