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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 />\ MY\ f 0 tb • 6 II k La it . 0 .. <br />OA... 00. As to 0 <br />�vc*(04:61.r c r 0 c s�.�1 <br />can c�r�e-t c \PK\� <br />U C-5( A m ovk-er x a\S �� cAvCVi r9 \i\&c <br />A,h Lrixi\ ch <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 />CoM/ -Applicant Signature <br />Printed Name <br />Jo <br />Printed Name <br />Title <br />CM5��,If <br />Title <br />Date <br />(,f2o/'L\ <br />Date <br />1 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. 1 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 />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 />