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Property Owner Information <br /> (if d0renr than Apyl tant1 <br /> Name: <br /> Street Address: u 5 W <br /> City,state,ZIP: S�J <br /> Home Phone. 125 Work Phone: <br /> Email: ��3���5 Fax Number: <br /> Please provide a detailed description of your request and attached a M of a scaled site IW <br /> kcre6azyillC.IJ+NG <br /> SEE __A!JY.ArQ _ _ AiALEA71VE SLALFP Szarl Pi AN. <br /> A "Land Use Sign"will be placed on the Subject Property to allow Ramsey Residents the <br /> opportunky to obtain information about your request <br /> Applicant Signature Co-Applicant Signature <br /> Printed Name - Printed Name <br /> Title Tile <br /> Date 0-7 66 1 ,903a 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. Arty excess of escrow acwurrt deposits over <br /> expenditures will be refunded at the time of account closure. I also understand that as the applicant,it is my responsRSky to obtain <br /> all other permits or licenses required by any applicable regulatory agencies for this Land Use Appiication. <br /> Property Owner Property Owner <br /> Signature Signature <br /> Printed Name Jff A� D OM fl Printed Name <br /> Title r-k?- Title <br /> Date 07 /,9 E> /ao Date <br /> I 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 />