Agenda - Council - 09/13/2022 - Laserfiche WebLink

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Property Owner Informadon different than APP*Conti Name: 13 PiErt_____Dioux Street Address: _ LAT gri; sr _A) 111/ ty, State, ZIP: - 0 3 Horne Phone: ..' e - Work Phone: Email: • ‘.. - 312 0 ALS Fax Number: Please provkle a detailed desalptlon of wur request and attached a co of a scaled site plan r, 1p 1 i At, e 0 Z.: P ideasiVN6 L _ IC S° e:,•)-1( 110 C_TOO S qj 4- Ai 6 ° QPFRxY Ai- 1 s--i-4 to lAtt-gT-pt sr ilAiti r ivi‘let_5F,±„ethEi5t ArrxtVrO Aiolz...) ScA,LED 5-irc P-A/V. A "Land Use Sign' will be placed on the Subject Property to allow Ramsey Residents the opportunity to obtain infoffnation about your req. , Applicant Signature -------- ff- 406/ Co -Applicant Sitnature Printed Name aD0BLE. BgsAi) v Printed Name , Title 1 Title Date 0-416 I 300 1 Date I 1 understand that the application fee is non-refundable. All costs associated with the processing of this applicatixt are the responsibility of the applicant whether this application is approved or denied. Any excess of esaow Malan cleposits over expenditures will be refunded at the time of account closure. i also understand that as the applicant it is wry responsibty to obtain all other permits or licenses required by any applicable regulatory agencies for this Land Use Application. Property Owner Signature Printed Name ris ri "Ad ri 44r Property Owner , Signature t3rA17.1( DoP 1_, 1:2- 'Printed Name Title Date 07 las I aon-- Date i hereby certify that 1 am the fee title owner/contract for deed vendee of record for the above -mentioned property. Failure to prove ownership may void any agreements entered into the City and 1 will be held liable for any and all costs incurred by the Oty.