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i' <br /> I. <br /> Property owner Information <br /> (if different than Applicant) <br /> Name; A 7' <br /> Street Address: 3 <br /> City,State,ZIP: <br /> I- <br /> Nome Phone; work Phone: <br /> Email: Fax Number: <br /> Please provide a detailed description of your request and attached a copy of a scaled site plan <br /> L . � <br /> AC9(;T..-# 7—A V VA P-A A L C,6ko%--' A0 Id <br /> 0 L/ 0 i A — A d a o'vi � <br /> � L AA �C)_.S J i <br /> &(;;w &0 <br /> raA <br /> G av�p e�/T- 7�r 7-ti j?4:f� �-J­a x,&�o cjV-si-4 tr <br /> AfvO 1VtWL--& a,^1 7-Ne /1-4 <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 /> r)A <br /> Applicant Signature Co-Applicant Signature <br /> Printed Name ----Printed Name <br /> L. C S _aq tt/o <br /> Title — Title <br /> Date �. �`Z� Dated <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 ov r <br /> expenditures will be refunded at the time of account closure. I also understand that as the applicant,it is my respon ility o o tain <br /> all other permits or licenses required by any applicable regulatory agencies for this Land Use Application. <br /> Property owner Property Owner <br /> ; <br /> Signature Signature <br /> Printed Name J;Ka Printed Name� <br /> C�c � <br /> Lg . <br /> Title Title <br /> Date .. 24 Z Date <br /> hereby certify that I am the fee title owner/contract for deed vendee of record for the above--mentioned property. Failure to prove <br /> f <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 />