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

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Property Owner Information (If different than Applicant) Name: Street Address: City, State, ZIP: Home Phone: Work Phone: Email: Fax Number: Please provide a detailed description of your request and attached a copy of a scaled site plan ( p‘ t ( A r8-cs, q (r)0 „F-- 1 (2)--‘c k, , J 3 "e CreC\ -eazi 5 IA -3 ak 1\4,r_, r-,e k '(1 ‘"O(NLej 10 CU1/4r4 I t) (1'4,C-de+ i ill (i) r6 P-Ul i )R *INI 6L5 C ) - - c\ e •is.efu1/401A1' 1 A "Land Use Sign" will be placed on the Subject Property to allow Ramsey Residents the op to obtain information about your request. e'r Applicant Signature ci,:001 .... Co -Applicant Signature ( V Printed Name (---.) e ,(\r\ eA. ,c, c ,1,5 :y6 m5Printed Name f,-- Title Title C OA Oc- Date '*--)z( -36 ' 3 .- Date I understand that the application fee is non-refundable. All costs associated with the processing of this application are the responsibility of the applicant whether this application is approved or denied. Any excess of escrow account deposits over expenditures will be refunded at the time of account closure. I also understand that as the applicant, it is my responsibility to obtain all other permits or licenses requiredanpiicable regulatory agencies for this Land Use Application. Property Owner Signature I Property Owner Signature Printed Name '.--.Ce.i'sr,\,e_A--ic ,--5 Printed Name ,s' V\ c ,:''''\• i'o 4-- :16 oe : (1 Title Title Date 15) c —5 6c- a -a 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 City.